胃癌术后全胃肠外营养治疗中患者出现低血糖的影响因素研究

严燕燕; 吴婉英; 付欢英; 俞鹏飞

doi:10.16766/j.cnki.issn.1674-4152.002385

胃癌术后全胃肠外营养治疗中患者出现低血糖的影响因素研究

doi: 10.16766/j.cnki.issn.1674-4152.002385

中国科学院大学附属肿瘤医院(浙江省肿瘤医院)腹部外科，浙江杭州 310022

基金项目:

浙江省自然科学基金项目 LY18H160032

详细信息

通讯作者:
吴婉英，E-mail: 764286275@qq.com

中图分类号: R735.2 R459.3
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- 文章访问数: 195
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- PDF下载量: 6
- 被引次数: 0
出版历程
- 收稿日期: 2021-03-29
- 网络出版日期: 2022-08-13

Influencing factors of hypoglycaemia in post-operative total parenteral nutrition therapy for gastric cancer

Department of Abdominal Surgery, the Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, Zhejiang 310012, China

摘要

摘要: 目的探讨胃癌术后患者在全胃肠外营养治疗期间出现低血糖的相关因素，为在临床治疗中降低患者低血糖发生率、为医护人员制定有效的预防和干预措施提供理论依据。方法依托临床电子病历系统，采用回顾性研究的方法，收集2018年1月1日—2019年12月31日在中国科学院大学附属肿瘤医院腹部外科行胃癌根治手术的974例患者信息，按照有无发生低血糖，分为低血糖组和非低血糖组，低血糖组为观察组，共126例，非低血糖组为对照组，共848例，采集其临床指标，2组比较年龄、性别、既往史、BMI、手术方式、用药情况和生化指标，单因素分析采用t检验及χ²检验，多因素分析采用二元logistic回归分析。结果本研究共纳入974名患者，男性660例(占比67.8%)，女性314例(占比32.2%)，年龄为(61.2±10.5)岁，发生低血糖126例(12.9%)。二元logistic回归分析显示：性别、BMI、既往糖尿病史、胰岛素葡萄糖配比与胃癌术后患者全胃肠外营养治疗期间低血糖的发生有关。结论护理中需关注高危人群，有针对性地从改善患者营养状态、安全合理用药、减少术后应激及禁食时间等方面入手，降低低血糖发生率。
- 胃癌 /
- 胃肠外营养 /
- 低血糖 /
- 影响因素分析
Abstract: Objective To explore the related factors of hypoglycaemia in patients with gastric cancer during total parenteral nutrition therapy and to provide a theoretical basis for reducing the incidence of hypoglycaemia in clinical treatment and for medical staff to formulate effective prevention and intervention measures. Methods A retrospective study was used to collect information on 974 patients who underwent radical gastric cancer surgery in the Department of Abdominal Surgery of the Tumor Hospital of the University of Chinese Academy of Sciences from January 1, 2018 to December 31, 2019. According to whether or not hypoglycaemia occurred, they were divided into hypoglycaemia group and non-hypoglycaemia group. The hypoglycaemia group was the observation group (126 cases), and the non-hypoglycaemia group was the control group (848 cases). The two groups compared their age, gender, past history, BMI, surgical methods, medication status and biochemical indicators. Univariate analysis was performed using t test and χ² test. Multivariate analysis adopted binary logistic regression analysis. Results A total of 974 patients were enrolled in this study, including 660 males (67.8%) and 314 females (32.2%), with an average age of (61.2±10.5) years. A total of 126 cases of hypoglycaemia were reported, with an incidence of 12.9%. Binary logistic regression analysis showed that gender, BMI, previous diabetes history, insulin and glucose ratio were related to the occurrence of hypoglycaemia during total parenteral nutrition therapy in patients after gastric cancer surgery. Conclusion In nursing care, attention should be paid to high-risk groups, and targeted measures should be taken to improve the nutritional status of patients, use drugs safely and rationally, reduce post-operative stress and fasting time and reduce the incidence of hypoglycaemia.
- Gastric cancer /
- Parenteral nutrition /
- Hypoglycaemia /
- Analysis of influencing factors

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表 1 974名胃癌手术患者临床基本情况

Table 1. Basic clinical data of 974 patients with gastric cancer undergoing surgery

项目	类别	例(%)
性别	男性	660(67.8)
	女性	314(32.2)
既往史	糖尿病	85(11.5)
	高血压	283(29.0)
	同时患有高血压糖尿病	42(4.3)
手术方式	腹腔镜手术	476(48.9)
	开腹手术	497(51.0)
	达芬奇机器人	1(0.1)
手术范围	胃近端切除	13(1.3)
	胃远端切除	639(65.6)
	全胃切除	322(33.1)
吻合方式	毕1吻合	127(13.0)
	毕2吻合	514(52.8)
	Rou-Y吻合	329(33.8)
	giraffe吻合	4(0.4)
BMI	＜18.5	99(10.2)
	18.5~20.5	179(18.4)
	20.6~23.9	402(41.3)
	＞24	294(30.2)

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表 2 2组一般资料比较(例)

Table 2. Comparison of general data between two groups (cases)

项目	观察组	对照组	χ²值	P值
年龄(岁)			21.886	＜0.001
＜40	5	30
41~50	8	88
51~60	21	248
61~70	54	351
＞70	38	131
性别			11.527	＜0.001
男性	102	558
女性	24	290
既往糖尿病史			5.614	0.018
有	18	67
无	108	781
BMI			58.845	＜0.001
＜18.5	31	68
18.5~20.5	38	141
20.6~23.9	42	360
＞24	15	279
手术方式			5.614	0.018
腹腔镜	62	414
开腹	63	434
机器人	1	0
既往有无高血压病史			0.253	0.601
有	39	244
无	87	604
手术范围
胃近端切除	2	11	0.564	0.754
胃远端切除	79	560
全胃切除	45	277
吻合方式			1.530	0.675
毕1	18	109
毕2	61	453
Rou-Y	46	283
giraffe	1	3

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表 3 手术前后2组生化指标的比较

Table 3. Comparison of biochemical indexes between the two groups before and after operation

项目	时间	观察组(n=126)	对照组(n=868)	统计量	P值
血清白蛋白(x±s，g/L)	术前	39.8±4.4	41.4±4.3	3.893^a	＜0.001
	术后	34.2±4.2	34.7±3.8	1.203^a	0.229
前白蛋白(x±s，mg/L)	术前	218.1±59.4	244.8±63.2	4.427^a	＜0.001
	术后	139.5±51.0	155.4±57.6	2.905^a	0.004
血红蛋白(x±s，g/dL)	术前	11.7±2.3	12.5±2.4	3.538^a	＜0.001
	术后	9.8±1.7	10.6±1.7	2.687^a	0.052
白细胞计数(x±s，×10⁹/L)	术前	5.79±1.9	6.0±2.0	0.989^a	0.323
	术后	7.6±2.6	7.9±2.7	0.872^a	0.383
中性粒细胞计数(x±s，×10⁹/L)	术前	3.8±1.6	3.8±1.8	0.371^a	0.711
	术后	5.9±2.4	6.0±2.4	0.432^a	0.666
淋巴细胞计数(x±s，×10⁹/L)	术前	1.5±0.5	1.6±0.6	2.362^a	0.018
	术后	1.0±0.5	1.1±0.5	0.916^a	0.360
丙氨酸氨基转移酶[M(P₂₅, P₇₅)，U/L]	术前	17.0(13.0，22.3)	19.0(25.0, 27.0)	3.602^b	＜0.001
	术后	18.5(15.0, 26.0)	22.0(16.0, 37.0)	3.100^b	0.001
总胆红素[M(P₂₅, P₇₅)，μmol/L]	术前	8.6(6.1, 11.6)	9.1(6.7, 12.2)	1.679^b	0.093
	术后	8.9(6.3, 12.6)	10.1(7.2, 14.1)	2.201^b	0.058
血肌酐(x±s，μmol/L)	术前	73.9±16.6	70.6±16.8	-2.010^a	0.045
	术后	65.7±24.0	60.9±17.0	-2.168^a	0.032
高密度脂蛋白(x±s，mmol/L)	术前	1.2±0.3	1.1±0.3	-2.688^a	0.008
低密度脂蛋白(x±s，mmol/L)	术前	2.6±0.7	2.7±0.8	1.378^a	0.169
C反应蛋白[M(P₂₅, P₇₅)，mg/L]	术后	45.3(26.6, 72.8)	44.7(24.4, 71.8)	0.369^b	0.712
注：^a为t值，^b为H值。

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表 4 胃癌术后患者全胃肠外营养液中葡萄糖与胰岛素配比比较(x±s)

Table 4. Comparison of the ratio of glucose and insulin in total parenteral nutrition solution in post operative patients with gastric cancer (x±s)

组别	糖尿病	非糖尿病
观察组	6.0±1.4	6.8±1.7
对照组	6.1±1.4	7.1±1.7
t值	0.376	1.397
P值	0.708	0.163

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表 5 变量赋值说明

Table 5. Description of variable assignment

自变量	赋值方法
性别	女=0，男=1
年龄(岁)	以实际值赋值
既往糖尿病史	否=0，是=1
BMI	＜18.5=1，18.6~=2，24~=3
血清白蛋白(g/L)	＜40=1，40~=2，55~=3
血肌酐(μmol/L)	＜59=1，59~=2，104~=3
丙氨酸氨基转移酶(U/L)	＜9=1，9~=2，50~=3
手术方式	开腹(Z1=0, Z2=0)，腹腔镜(Z1=1, Z2=0)，达芬奇机器人(Z1=0, Z2=1)
葡萄糖与胰岛素配比	以实际值赋值
前白蛋白(mg/L)	＜170=1，170~=2，420~=3
血红蛋白(g/dL)	＜130=1，130~=2，175~=3
淋巴细胞计数(10⁹/L)	＜1.1×10⁹/L=1，1.1×10⁹/L~=2，1.3×10⁹/L~=3

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表 6 胃癌术后患者全胃肠外营养治疗期间低血糖危险因素logistic回归分析结果

Table 6. Logistic regression analysis of risk factors for hypoglycemia during total parenteral nutrition in postoperative patients with gastric cancer

项目	B	SE	Wald χ²	P值	OR值	95% CI
性别	0.910	0.295	9.521	0.002	2.484	1.393~4.429
年龄	0.151	0.124	1.466	0.226	1.163	0.912~1.483
既往糖尿病史	1.130	0.361	9.817	0.002	3.097	1.527~6.281
血清白蛋白(术前)	-0.032	0.251	0.016	0.900	0.969	0.589~1.593
BMI	-0.752	0.126	35.469	＜0.001	0.465	0.368~0.603
血肌酐(术前)	0.009	0.009	0.909	0.340	1.009	0.991~1.027
血肌酐(术后)	0.002	0.008	0.088	0.767	1.002	0.986~1.019
丙氨酸氨基转移酶(术前)	0.230	0.433	0.282	0.595	1.259	0.539~2.941
丙氨酸氨基转移酶(术后)	-0.374	0.336	1.241	0.265	0.688	0.356~1.329
葡萄糖胰岛素配比	-0.174	0.069	6.394	0.011	0.842	0.734~0.962
腹腔镜	-0.456	0.228	4.036	0.051	0.634	0.405~0.991
前白蛋白(术前)	-0.058	0.325	0.032	0.858	0.954	0.499~1.784
前白蛋白(术后)	-0.371	0.253	2.143	0.143	0.689	0.420~1.133
血红蛋白(术前)	-0.220	0.172	1.638	0.201	0.804	0.573~1.124
淋巴细胞计数(术前)	-0.124	0.277	0.200	0.655	0.883	0.513~1.520
高密度脂蛋白	0.463	0.317	2.132	0.144	1.599	0.854~2.957
注：因达芬奇机器人手术只有1例，故不纳入回归分析。

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