| Objective To control the fluctuation of blood glucose is a new concern for the prevention and treatment of diabetes.This topic provides a reference for the perioperative clinical monitoring of patients with diabetes by studying the changes of blood glucose before and after the ocular operations and evaluating the influencing factors.Methods 132 patients with diabetes combined with ocular diseases in the Qilu hospital of Shandong University from January 2016 to May 2017 were treated with cataract extraction and intraocular lens implantation and/or vitrectomy.The ocular diseases were vitreous hemorrhage,retinal detachment,and cataract,silicon oil eye,etc.All patients received blood glucose test at the following time points:preoperative fasting blood glucose,2hrs after breakfast,2hrs after lunch,10pm,30min after operation.From at least one day before to two days after operation.Blood glucose were compared for changes before and after the operation.To study the factors influencing the changes in blood glucose,patients were divided into different groups respectively:According to the preoperative fasting blood glucose level,patients were divided into two groups:1.Poorly controlled group,40 cases whose preoperative fasting blood glucose was>10mmol/L,2.Well controlled group:92 cases whose preoperative fasting blood glucose was ?10mmol/L;According to the length of operation time,132 patients were divided into three groups:1.Short group:the operation time was less than 30min,average 27.2± 2.4min,45 cases,all were cataract surgeries,2.Middle group:operation time 31-90min,average 46.3 ± 3.1 min,53 cases,including 34 cases of vitrectomy,8 cases of cataract surgery,6 cases of silicone oil extraction,5 cases of silicone oil extraction + intraocular lens implantation.3.Long group:The operation time was>90min,an average of 91.3± 5.4min,a total of 42 cases,including 20 cases of vitrectomy,14 cases of cataract surgery + vitrectomy,8 cases of silicone oil extraction + intraocular lens implantation.According to the course of time after diagnosis of diabeties,132 diabetic patients were divided into three groups,1.Short groups:a total of 38 cases,the course of diabetis was 1-5 years,average 2.5 ± 0.4 years;2.Middle group:27 cases,the course of diabetis was 6-10 years,average 6.8 ± 1.2 years,3.Long group:67 cases,the course of diabetis was over 10 years(11-27years),average 17.4±2.1 years.The effect of blood glucose control,operation time,and the course of diabetes on the level of blood glucose fluctuations were analysed respectively.Results The average blood glucose of the 132 patients was 9.81 ± 1.29 mmol/L before operation,and was 13.04 ± 1.83mmol/L 30min after operation,the average increase was 3.22±2.19mmol/L.There was significant difference(paired t test,p<0.01).There was no significant difference between sexes.The concentration of fasting blood glucose before operation in diabetic patients was 8.15±1.64mmol/L,the average blood glucose of 2hrs after breakfast was 12.44 ± 2.11 mmol/L,the average blood glucose of 2hrs after lunch was 11.15± 2.13mmol/L,the average blood glucoseat 10pm was 10.84 ± 1.87mmol/L,and the average blood glucose was 9.81 ±1.29mmol/L on the corresponding time before operation,the average blood glucose was 13.04 ± 1.83mmol/L 30min after operation.One day after operation,the blood glucose was 8.63 ± 1.02mmol/L at fasting,11.03 ± 1.16mmol/L at the corresponding operation time,Two days after operation,the blood glucose was 8.25 ± 1.26 mmol/L at fasting,10.10 ± 1.47mmol/L at the corresponding operation time.The blood glucose level at 30min,one day and two days after operation was significantly higher than that before operation(p<0.05).To evaluate the effect of glucose control on the changes of blood glucose,the analysis showed that the blood glucose change values at 30min(4.10±2.15 VS 2.13 ±1.69,mmol/L,p<0.01)and 1D time point(0.05 ±1.11 VS 2.02 ± 1.99,mmol/L,p<0.01)after operation were higher in the 'poorly controlled' group than those in the 'well controlled' group(p<0.01),there was no significant difference between the two groups for the changes two days after operation(0.30 ± 0.98 VS 0.28±0.52,p>0.05).To evaluate the effect of operation time on the changes of blood glucose,patients in the three groups were compared for the changes of blood glucose at different time points.For the change at 30min after operation,There were significant differences between the short group(1.86±1.71mmol/L)with the middle group(3.20±2.01 mmol/L)and the long group(3.50±2.13 mmol/L)(p<0.01).,There was no significant difference between the middle group and the long group(p>0.05).For the changes at the corresponding time 1 day after operation,There were significant differences between the short group(0.56±1.24 mmol/L)with the middle group(1.40±2.26 mmol/L)and the long group(1.49±1.96 mmol/L)(p<0.05).,There was no significant difference between the middle group and the long group(p>0.05).There were no significant differences among the three groups 2 days after the operation(short group 0.37±0.75 mmol/L,middle group 0.28±0.56 mmol/L,long group 0.19±1.00 mmol/L,p>0.05).For the changes at fasting time 1 day after operation,there was significant statistical difference between the short group(-0.03±1.22mmol/L)with the middle group(0.76±1.05mmol/L)and the long group(0.70±0.96mmol/L)(p<0.05),there was no significant statistical difference between the middle group and the long group(p>0.05);For the changes at fasting time 2 days after operation,there was significant statistical difference between the short group(-0.12±0.56mmol/L)with the middle group(0.22±0.78mmol/L)and the long group(0.21±0.75mmol/L)(p<0.05),there was no significant statistical difference between the middle group and the long group(p>0.05).To evaluate the effect of the course of diabetis on the changes of blood glucose,the results showed that for the changes at 30 min after operation,there were no significant statistical differences among the short group(2.77±2.08 mmol/L),the middle group(2.83±2.03 mmol/L)and the long group(3.63±2.25 mmol/L)(p>0.05);For the changes at the corresponding time 1 day after operation,there was no significant statistical difference between the short group(1.08±1.31 mmol/L)and the middle group(0.30±2.33 mmol/L)(p>0.05)?the short group and the long group(1.50±1.95 mmol/L)(p>0.05),there was significant statistical difference between the middle group and the long group(p<0.05);For the changes at the corresponding time 2 days after operation,there wes no significant statistical difference between the short group(1.59±0.92 mmol/L)and the middle group(0.11±0.63 mmol/L)(p>0.05)?the short group and the long group(0.43±0.69 mmol/L)(p>0.05),there was significant statistical difference between the middle group and the long group(p<0.05);For the changes at fasting time 1 day after operation,there was significant statistical difference between the short group(0.13±1.48mmol/L)and the long group(0.72±0.85mmol/L)(p<0.05),there was no significant statistical difference between the short group and the middle group(0.34±1.16 mmol/L)(p>0.05)?the middle group and the long group(p>0.05);For the changes at fasting time 2 days after operation,there was no significant statistical difference among the short group(0.00±0.84 mmol/L)?the middle group(0.15±0.62 mmol/L)and the long group(0.14±0.68 mmol/L)(p>0.05).Conclusion1.The blood glucose level of diabetic patients increased 30min and one day after operation,and returned to preoperative level two days after operation.2.The blood glucose fluctuation in the 'well controlled' operation group(preoperative fasting blood glucose<10mmol/L)was smaller than that in the' poorly controlled' group(preoperative fasting blood glucose ? 10mmol/L).3.The shorter the duration of the operation time,the less the fluctuation of blood glucose before and after operation.4.The longer duration of diabetes caused greater fluctuation of blood glucose before and after operation.5.Intensive perioperative blood glucose monitoring and shortening the operation time will be helpful for the control of the fluctuation of blood glucose and for the treatment of diabetic patients undergoing ophthalmic surgery. |
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