Application of real-time continuous glucose monitoring in perioperative blood glucose management of patients undergoing pancreatectomy under the concept of enhanced recovery after surgery
10.3760/cma.j.cn211501-20240208-00340
- VernacularTitle:加速康复外科理念下实时持续葡萄糖监测在胰腺切除患者围手术期血糖管理中的应用
- Author:
Lei CUI
1
;
Huiping YU
1
;
Kuirong JIANG
1
;
Xiaoping FANG
1
Author Information
1. 南京医科大学第一附属医院胰腺中心，南京 210029
- Publication Type:Journal Article
- Keywords:
Pancreatectomy;
Fingertip blood glucose monitoring;
Real-time continuous glucose monitoring;
Glycemic management;
Enhanced recovery after surgery
- From:
Chinese Journal of Practical Nursing
2024;40(36):2805-2811
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the effects of real-time continuous glucose monitoring (Rt-CGM) on perioperative blood glucose and health-related outcomes in patients undergoing pancreatectomy under the concept of enhanced recovery after surgery (ERAS), in order to provide theoretical guidance for perioperative blood glucose management in pancreatic specialists.Methods:This was a retrospective and analytical study. A total of 244 patients who underwent pancreatectomy for malignant tumors at the Pancreas Center of the First Affiliated Hospital of Nanjing Medical University from January to June 2023 were selected by the convenience sampling method. The patients who used Rt-CGM during the perioperative period were selected as the observation group ( n=74), and the patients who used fingertip blood glucose monitoring were selected as the control group ( n=170). After the propensity score matching method was used to balance the general and disease-related data of the two groups of patients, the differences in perioperative blood glucose levels and health outcomes of the two groups (both n=69) were compared. Results:Before propensity score matching, the aminotransferase levels, surgical methods and postoperative ICU admission ratio of the control group were 27.3(15.4, 120.0)U/L, 58.2%(99/170)(pancreaticoduodenectomy) and 41.8%(71/170)(distal pancreatectomy), 18.8%(32/170); while those in the observation group were 47.2(19.0, 190.5)U/L, 73.0%(54/74)(pancreaticoduodenectomy) and 27.0%(20/74)(distal pancreatectomy), 32.4%(24/74). There were statistical differences between the two groups ( Z=-2.02, χ2=4.79, 5.40, all P<0.05). After propensity score matching, there were no statistically significant differences in general and disease-related data between the two groups (all P>0.05). When it came to blood sugar control, the fluctuation range of fasting blood glucose, pre-dinner blood glucose, 2 h post-dinner blood glucose, postmeal blood glucose and coefficient of variation of fasting blood glucose in observation group were (8.0 ± 2.0), (9.7 ± 2.0), (10.4 ± 2.3), (1.1 ± 0.5) mmol/L and (0.2 ± 0.1), respectively, significantly lower than (8.9 ± 1.7), (10.7 ± 2.1), (11.2 ± 2.4), (3.0 ± 1.7) mmol/L and (0.3 ± 0.1) of the control group, the difference was statistically significant ( t values were -8.81 to -2.04, all P< 0.05). In terms of health outcomes, the incidence of grade B pancreatic fistula and chylous fistula in the observation group were 0(0/69), respectively, which were significantly lower than 20.3% (14/69) and 5.8% (4/69) in the control group, the differences were statistically significant ( χ2=32.58, 8.77, both P<0.05). The median length of hospital stay in the observation group was 14.0(12.0, 18.0) days, which was significantly lower than 17.0 (14.0, 24.0) days in the control group, the difference was statistically significant ( Z=-2.90, P<0.05). Conclusions:The application of real-time continuous glucose monitoring in perioperative blood glucose management of patients undergoing pancreatectomy can significantly reduce blood glucose level, control blood glucose fluctuation, reduce postoperative complications and shorten the length of hospital stay. Therefore, it is an essential help for ERAS to carry out good perioperative blood glucose management.
