Effects of glucose-insulin infusion during major oral and maxillofacial surgery on postoperative complications and outcomes.
Effects of glucose-insulin infusion during major oral and maxillofacial surgery on postoperative complications and outcomes.
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DOI：
10.1186/s40981-018-0148-3
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发表时间：
2018
影响因子：
0.9
通讯作者：
Sugimura M
中科院分区：
文献类型：
--
作者：
Tohya A;Kohjitani A;Ohno S;Yamashita K;Manabe Y;Sugimura M
对抗胰岛素作用的激素的分泌在对手术的反应中被促进，并且对胰岛素作用的急性抗性发展。我们的目的是阐明术中血糖控制的葡萄糖-胰岛素（GI）输注对术后并发症和结果的影响，在口腔颌面部大手术。对30例年龄≥ 60岁的口腔恶性肿瘤根治术伴组织重建（≥ 8h）患者进行分析。在GI组中，常规胰岛素与添加葡萄糖的乙酸林格氏溶液（5-10 g葡萄糖/500 mL）一起持续应用。将血糖调节在80-120 mg/dL的目标浓度范围内。对照组用含1%（W/V）葡萄糖的醋酸盐林格氏液和不含葡萄糖的乳酸盐林格氏液。围手术期临床参数、低白蛋白血症发生率和术后并发症，即，比较手术部位感染、再造皮瓣坏死、菌血症、低血压或肺炎。GI组的血清总蛋白和白蛋白浓度（术后第1天[第1天]）均较高。手术期间葡萄糖的平均输注速率（mg/kg/h）与对照组至第1天的血清总蛋白和白蛋白浓度降低独立相关。除了GI组低白蛋白血症的发生率较低外，两组之间在术后并发症的发生率和出院前所需的天数方面没有差异。口腔颌面部大手术中补充葡萄糖对血清白蛋白浓度的保护作用。然而，这并没有导致术后并发症减少和出院天数减少。
Secretion of hormones, which antagonize the action of insulin, is facilitated in response to surgery, and acute resistance to the action of insulin develops. Our aim is to elucidate the effects of intraoperative glycemic control by glucose-insulin (GI) infusion on postoperative complications and outcomes in major oral and maxillofacial surgery. Thirty patients aged ≥ 60 years undergoing a radical operation of oral malignant tumors with tissue reconstruction (≥ 8 h) were analyzed. In the GI group, regular insulin was continuously applied with glucose-added acetate Ringer’s solution (5–10 g glucose per 500 mL). Blood glucose was adjusted within the target concentration of 80–120 mg/dL. In the control group, combination of acetate Ringer’s solution containing 1% (W/V) glucose and lactate Ringer’s solution, which contains no glucose, was employed. Perioperative clinical parameters, incidence of hypoalbuminemia, and postoperative complications, i.e., surgical site infection, necrosis of a reconstructed flap, bacteremia, hypotension, or pneumonia, were compared. Both serum total protein and albumin concentrations (postoperative day 1 [Day1]) were higher in the GI group. The mean infusion rate of glucose during surgery (mg/kg/h) was independently associated with the decrease in both serum total protein and albumin concentrations from the control to Day1. No difference was found between the groups in the incidence of postoperative complications and the days required until discharge, except less incidence of hypoalbuminemia in the GI group. Application of additional glucose during major oral and maxillofacial surgery preserved serum albumin concentration. However, it did not lead to less postoperative complications and less days until discharge.