Study On Application Of Perioperative Blood Glucose Monitoring Scheme In Patients With Abnormal Blood Glucose In Orthopedic Trauma Department

Objective: The purpose of this study was to establish a method for monitoring blood glucose in patients with abnormal blood glucose in traumatic Department of orthopedics.Specific research objectives includes:(1)To investigate the monitoring status of abnormal blood glucose in a trauma department of orthopedics in a hospital of Shanghai.(2)To establish a scheme of monitoring perioperative blood glucose in orthopedic trauma patients.(3)To evaluate the feasibility of the scheme and to describe the perioperative blood glucose level in orthopedic trauma patients.Method:(1)The researchers reviewed the present situation of abnormal blood glucose in trauma department of orthopedics of this hospital.(2)By literature review,qualitative interviews form the preliminary monitoring program,and then a total of 10 specialists engaged in clinical medical treatment,nursing and nursing management areas conducted a consultation.According to their advice we constructed a perioperative blood glucose monitoring scheme of abnormal blood glucose in orthopedic trauma patients.(3)350 cases from orthopedics ward of a hospital in Shanghai were included in this study,then we used the scheme for the monitoring of perioperative blood glucose and evaluate the feasibility of this scheme.Results:(1)Hyperglycemia of orthopedic trauma patients during the perioperative period do exsits,and the incidence of hyperglycemia was 11.5%;In these hyperglycemic patients,only 32.2% were monitored;Not only patients with Diabetes but also those with out Diabetes were lack of postoperative monitoring.(2)After two rounds of expert consultation,we conducted a scheme including 1 first grade item,8 second grade items,20 third grade items to monitor the blood glucose during perioperative fasting period.Among them,the expert authority coefficient was0.91,the coefficient of variation was between 0-0.23,Kendall ’s W coefficient was 0.453(P<0.01).(3)350 patients were divided into diabetic group(n=206)and non-diabetic group(n=144),the blood glucose values of each monitoring point were compared and there was no difference in baseline data.Among them,the average fasting blood glucose the day before surgery of diabetic group was 8.78±2.32mmol/L,which was lower than that 9.63±2.91mmol/L of the day after surgery(P<0.05);the average fasting blood glucose the day before surgery of non-diabetic group was 9.41±2.20mmol/L,which was lower than that 9.90±1.96mmol/L of the day after surgery(P<0.05);They all belong to high blood glucose range,the difference was statistically significant.The blood glucose values of two groups in perioperative fasting period were as follows: bedtime blood glucose of the day before surgery were 9.98±2.32mmol/L(diabetic group)and 10.28±2.17mmol/L(non-diabetic group);6am blood glucose on the day of surgery were 8.27±1.94mmol/L(diabetic group)and 8.98±2.26mmol/L(non-diabetic group);blood glucose at the time of leaving the ward were 7.39±1.64mmol/L(diabetic group)and 8.05±1.86mmol/L(non-diabetic group);blood glucose at the time of returning the ward were9.21±2.50mmol/L(diabetic group)and 9.29±2.54mmol/L(non-diabetic group);blood glucose before meal after surgery were8.75±2.63mmol/L(diabetic group)and 8.83±1.94mmol/L(non-diabetic group).Two groups of patients with fasting bloodglucose changes were first decreased and then increased and then decreased in perioperative period.Hypoglycemia exists in perioperative period of orthopedic trauma patients.Conclusion:(1)Hyperglycemia of orthopedic trauma patients during the perioperative period do exist,including diabetic and non-diabetic patients.(2)The perioperative period abnormal blood glucose monitoring scheme of orthopedic trauma patients is feasible.After verification,it can monitor the changes of blood glucose in patients in perioperative period,and timely detect high or low blood glucose level,informing the doctor for treatment,avoiding the occurrence of adverse events.(3)The blood glucose level of patients with abnormal blood glucose in orthopedic trauma ward is increased after surgery,including diabetic and non-diabetic patients.And hypoglycemia occurs in diabetic patients in these period.The clinicians need to strengthen the monitoring of perioperative blood glucose,especially for the monitoring of patients with non-diabetic hyperglycemia.