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

doi:10.11958/20230390

Abstract

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

CLC Number:

R614.2

Figures/Tables 3

References 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