术中血糖波动和术后胰岛素抵抗对胸腔镜肺癌根治术后老年患者认知功能障碍的影响

doi:10.11958/20230390

天津医药 ›› 2024, Vol. 52 ›› Issue (2): 201-205.doi: 10.11958/20230390

术中血糖波动和术后胰岛素抵抗对胸腔镜肺癌根治术后老年患者认知功能障碍的影响

陈慧敏¹(), 贾洪峰¹, 江婷婷¹, 贾耀辉²^,^△()

1.西安交通大学医学部附属三二〇一医院麻醉科（邮编723000），2.神经外科

收稿日期:2023-03-19 修回日期:2023-07-24 出版日期:2024-02-15 发布日期:2024-01-26
通讯作者: ^△ E-mail：jiayh136@163.com
作者简介:陈慧敏（1983），女，副主任医师，主要从事胸外科手术麻醉的基础和临床方面研究。E-mail：chenhmls@163.com

Effects of intraoperative blood glucose fluctuation and postoperative insulin resistance on cognitive dyfunction in elderly patients after thoracoscopic radical resection of lung cancer under general anesthesia

CHEN Huimin¹(), JIA Hongfeng¹, JIANG Tingting¹, JIA Yaohui²^,^△()

1. Department of Anesthesiology, 2. Department of Neurosurgery, 3201 Hospital Affiliated to Medical Department of Xi'an Jiaotong University, Hanzhong 723000, China

Received:2023-03-19 Revised:2023-07-24 Published:2024-02-15 Online:2024-01-26
Contact: ^△ E-mail: jiayh136@163.com

陈慧敏, 贾洪峰, 江婷婷, 贾耀辉. 术中血糖波动和术后胰岛素抵抗对胸腔镜肺癌根治术后老年患者认知功能障碍的影响[J]. 天津医药, 2024, 52(2): 201-205.

CHEN Huimin, JIA Hongfeng, JIANG Tingting, JIA Yaohui. Effects of intraoperative blood glucose fluctuation and postoperative insulin resistance on cognitive dyfunction in elderly patients after thoracoscopic radical resection of lung cancer under general anesthesia[J]. Tianjin Medical Journal, 2024, 52(2): 201-205.

摘要/Abstract

摘要：

目的分析术中血糖波动和术后胰岛素抵抗（IR）对老年全麻胸腔镜肺癌根治术患者术后认知功能障碍（POCD）的影响。方法收集352例老年全麻胸腔镜肺癌根治术患者，分为POCD组（84例）和非POCD组（268例），利用倾向性评分匹配法（PSM）均衡2组间协变量，84例匹配成功，比较PSM前后2组资料差异。PSM后，绘制血糖波动幅度预测POCD的受试者工作特征（ROC）曲线，根据截断值分为低水平血糖波动组（97例）和高水平血糖波动组（71例），并根据术后是否发生IR分为IR组（53例）和非IR组（115例），比较组间POCD发生率。采用Logistic回归分析POCD的影响因素。结果 PSM前，POCD组的年龄、血糖波动幅度、IR比例、手术时间、麻醉时间、麻醉维持期间丙泊酚用量、瑞芬太尼用量和舒芬太尼用量大于非POCD组（P<0.05）；PSM后，POCD组血糖波动幅度和IR比例大于非PCOD组（P<0.05）。PSM后，高水平血糖波动组和IR组POCD发生率分别高于低水平血糖波动组和非IR组（P<0.05）。Logistic回归显示，术中血糖波动幅度大（OR=9.140，95%CI：4.338~19.257）和术后发生IR（OR=4.034，95%CI：1.163~13.991）是POCD的危险因素。结论术中血糖波动幅度大和术后发生IR的老年全麻胸腔镜肺癌根治术患者POCD发生风险升高。

关键词: 血糖, 胰岛素抵抗, 胸腔镜检查, 麻醉, 全身, 术后认知并发症, 认知功能障碍, 老年人, 肺癌根治术

Abstract:

Objective To analyze the influence of intraoperative blood glucose fluctuation and postoperative insulin resistance (IR) on postoperative cognitive dyfunction (POCD) in elderly patients undergoing thoracoscopic radical resection of lung cancer under general anesthesia. Methods A total of 352 elderly patients undergoing thoracoscopic radical resection of lung cancer under general anesthesia were collected and divided into the POCD group (n=84) and the non-POCD group (n=268). The covariates between the two groups were balanced by propensity score matching method (PSM). Eighty-four cases in each group were successfully matched. The data between the two groups before and after PSM were compared. After PSM, receiver operating characteristic (ROC) curve of blood glucose fluctuation amplitude for predicting POCD was drawn, and patients were divided into the low-level blood glucose fluctuation group (n=97) and the high-level blood glucose fluctuation group (n=71) according to the cut-off value. According to the existence of postoperative IR, patients were divided into the IR group (n=53) and the non-IR group (n=115). Then, incidences of POCD between groups were compared. Logistic regression was used to analyze the influencing factors of POCD. Results Before PSM, the POCD group had older age, higher blood glucose fluctuation amplitude, IR ratio, operation time, anesthesia time, propofol dosage, remifentanil dosage and sufentanil dosage in anesthesia maintenance period than those in the non-POCD group (P<0.05). The POCD group had higher blood glucose fluctuation amplitude and IR ratio than those in the non-POCD group after PSM (P<0.05). After PSM, the incidences of POCD in the high-level blood glucose fluctuation group and the IR group were higher than those in the low-level blood glucose fluctuation group and the non-IR group (P<0.05). Logistic regression analysis showed that higher intraoperative blood glucose fluctuation (OR=9.140, 95%CI: 4.338-19.257) and postoperative IR (OR=4.034, 95%CI: 1.163-13.991) were risk factors of POCD. Conclusion The risk of POCD in elderly patients undergoing thoracoscopic radical lung cancer surgery under general anesthesia is increased in patients with higher intraoperative blood glucose fluctuation and postoperative IR.

Key words: blood glucose, insulin resistance, thoracoscopy, anesthesia, general, postoperative cognitive complications, cognitive dysfunction, aged, radical lung cancer surgery

中图分类号:

R614.2

图/表 3

参考文献 24

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组别		n	性别（男/女）		年龄/岁		BMI/（kg/m²）		吸烟		饮酒		高血压	高脂血症		ASA分级（Ⅱ级/Ⅲ级）
非POCD组1		268	186（69.4）/82（30.6）		70.01±5.10		23.96±3.15		182（67.9）		102（38.0）		101（37.7）	95（35.4）		102（38.1）/166（61.9）
非POCD组2		84	54（64.3）/30（35.7）		71.83±5.76		24.06±2.89		56（66.7）		29（34.5）		26（31.0）	31（36.9）		31（36.9）/53（63.1）
POCD组		84	58（69.0）/26（31.0）		72.67±6.18		24.01±2.99		52（61.9）		25（29.8）		23（27.4）	34（40.5）		35（41.7）/49（58.3）
χ₁²或t₁			0.004		3.943^＊＊		0.117		1.035		1.909		2.977	0.697		0.350
χ₂²或t₂			0.429		0.904		0.110		0.415		0.437		0.259	0.226		0.399
组别	IR			术前1 d MMSE评分/分		血糖波动幅度/（mmol/L）		手术时间/min		麻醉时间/min		麻醉维持期丙泊酚用量/ （mg/kg）			麻醉维持期瑞芬太尼用量/（μg/kg）		麻醉维持期舒芬太尼用量/（μg/kg）
非POCD组1	44（16.4）			28.46±1.14		2.03±0.64		133.60±26.97		173.42±34.47		11.13±2.25			1.11±0.22		0.38±0.11
非POCD组2	16（19.0）			28.33±1.13		2.05±0.59		138.92±30.92		195.96±36.31		11.58±2.58			1.16±0.26		0.45±0.12
POCD组	37（44.0）			28.33±1.10		5.09±2.05		146.14±42.44		202.65±48.87		12.18±3.54			1.22±0.35		0.48±0.15
χ₁²或t₁	27.558^＊＊			0.915		21.386^＊＊		3.201^＊＊		6.104^＊＊		3.199^＊＊			3.191^＊＊		6.821^＊＊
χ₂²或t₂	12.156^＊＊			<0.001		13.081^＊＊		1.261		1.007		1.262			1.261		1.466

组别		n	性别（男/女）		年龄/岁		BMI/（kg/m²）		吸烟		饮酒		高血压	高脂血症		ASA分级（Ⅱ级/Ⅲ级）
非POCD组1		268	186（69.4）/82（30.6）		70.01±5.10		23.96±3.15		182（67.9）		102（38.0）		101（37.7）	95（35.4）		102（38.1）/166（61.9）
非POCD组2		84	54（64.3）/30（35.7）		71.83±5.76		24.06±2.89		56（66.7）		29（34.5）		26（31.0）	31（36.9）		31（36.9）/53（63.1）
POCD组		84	58（69.0）/26（31.0）		72.67±6.18		24.01±2.99		52（61.9）		25（29.8）		23（27.4）	34（40.5）		35（41.7）/49（58.3）
χ₁²或t₁			0.004		3.943^＊＊		0.117		1.035		1.909		2.977	0.697		0.350
χ₂²或t₂			0.429		0.904		0.110		0.415		0.437		0.259	0.226		0.399
组别	IR			术前1 d MMSE评分/分		血糖波动幅度/（mmol/L）		手术时间/min		麻醉时间/min		麻醉维持期丙泊酚用量/ （mg/kg）			麻醉维持期瑞芬太尼用量/（μg/kg）		麻醉维持期舒芬太尼用量/（μg/kg）
非POCD组1	44（16.4）			28.46±1.14		2.03±0.64		133.60±26.97		173.42±34.47		11.13±2.25			1.11±0.22		0.38±0.11
非POCD组2	16（19.0）			28.33±1.13		2.05±0.59		138.92±30.92		195.96±36.31		11.58±2.58			1.16±0.26		0.45±0.12
POCD组	37（44.0）			28.33±1.10		5.09±2.05		146.14±42.44		202.65±48.87		12.18±3.54			1.22±0.35		0.48±0.15
χ₁²或t₁	27.558^＊＊			0.915		21.386^＊＊		3.201^＊＊		6.104^＊＊		3.199^＊＊			3.191^＊＊		6.821^＊＊
χ₂²或t₂	12.156^＊＊			<0.001		13.081^＊＊		1.261		1.007		1.262			1.261		1.466

变量	B	SE	Wald χ²	P	OR（95%CI）
血糖波动幅度	2.213	0.380	33.864	<0.001	9.140（4.338~19.257）
IR	1.395	0.635	4.831	0.028	4.034（1.163~13.991）
常数项	-6.881	1.107	38.647	<0.001	0.001

变量	B	SE	Wald χ²	P	OR（95%CI）
血糖波动幅度	2.213	0.380	33.864	<0.001	9.140（4.338~19.257）
IR	1.395	0.635	4.831	0.028	4.034（1.163~13.991）
常数项	-6.881	1.107	38.647	<0.001	0.001

术中血糖波动和术后胰岛素抵抗对胸腔镜肺癌根治术后老年患者认知功能障碍的影响

Effects of intraoperative blood glucose fluctuation and postoperative insulin resistance on cognitive dyfunction in elderly patients after thoracoscopic radical resection of lung cancer under general anesthesia

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