A Clinical Study Of Patients Undergoing Elective Abdominal Surgery Perioperative Of Hospital Hyperglycemia

Objective:Investigation and Changzhi Ji Hospital General Surgery, Affiliated Hospital of Medical College, the incidence of high blood sugar, give them control situation assessment. Observe upper abdominal surgery were Preoperative blood sugar investigate preoperative glycemic load on blood sugar after surgery cause stress hyperglycemia impact and HOMA index. Method:at 0:00 on May 20, 2014--- at 0:00 on May 21, 2014 Changzhi Medical College and Hospital for inpatients(except pediatric) to investigate, collect past medical history, current medications, ask Patients with a history of smoking and drinking, while recording gender, age, height, weight, blood pressure and general information collected fasting plasma glucose(FPG), all blood glucose values during hospitalization, total cholesterol(TC), triglyceride(TG), high density lipoprotein cholesterol(HDL-C), low-density lipoprotein cholesterol(LDL-C), uric acid, liver function(ALT, AST), r-GT renal function(BUN, Cr) and other biochemical markers, calculate body mass index(BMI), Calculation of nosocomial prevalence of high blood sugar, high blood sugar hospital management application tool, the quality of hyperglycemia score((The Quality Hyperglycemia Score, QHS)), management and economic evaluation of the current situation in hospitals hyperglycemia Yale University.Select patients undergoing elective abdominal surgery 40 cases, patients on a voluntary basis, exclude the following patients: ① upper abdominal surgery patients underwent emergency surgery or abdominal surgery, ② patients with previous history of diabetes, thyrotoxicosis endocrine diseases, ③ a history of delayed gastric emptying, patients with a history of gastrointestinal obstruction, ④ pregnant women, ⑤ liver and kidney dysfunction, ⑥ BMI <19 kg / m2, BMI> 25 kg / m2. Eligible patients for general information recording gender, age, height, weight, blood pressure, liver and kidney function, medical history and so on, were randomly divided into two groups: control group, glycemic load group. The control group routine preoperative fasting 8-12 hours, three hours before the group of patients administered glucose load glucose load, front or 12.5% glucose solution 400 ml, 2 hours before surgery finished taking measured postoperative one day, after 3 The days of fasting plasma glucose and insulin were measured and insulin secretion index(HOMA-IS), insulin sensitivity index(HOMA-ISI) and insulin resistance index(HOMA-IR). Formula: insulin resistance index =(fasting blood glucose concentration × fasting insulin concentration) 22.5; ISI = 1 /(fasting plasma glucose concentration of the common logarithm of fasting insulin concentration + common logarithm); insulin secretion index =(fasting insulin concentration × 20) /(fasting blood glucose-3.5). Results:Changzhi Ji Hospital General Surgery, Affiliated and incidence of hyperglycemia in hospital medicine, and QHS score analysis: 1) A total of 462 hospitalized patients, hospital hyperglycemia incidence of 19.2%(89), which have been diagnosed with diabetes 40 patients(8.7%), and hospital surgical system average incidence of hyperglycemia 11.1% general surgery surgical system, the highest incidence of hyperglycemia in hospital departments, the rate was 15%. 2) All inpatient glycemic application QHS scoring system analysis, normal blood glucose range(3.9-10.0mmol / L) levels of 64%, severe hyperglycemia(> 16.7mmol / L)(11.7%), hypoglycemia(2.8-3.9mmol / L) accounts for 1.5%, QHS score of 72 points, including general surgery, 60% of normal blood sugar levels, severe hyperglycemia(12.5%), 27.5% of high blood sugar, no hypoglycemia and severe hypoglycemia, QHS score of 70 points, hospital hyperglycemia control situation is not optimistic, general surgery hospital ranks high glycemic control overall moderate level.patients undergoing elective abdominal surgery Preoperative blood sugar, preoperative glycemic load cause blood sugar after the impact of stress hyperglycemia and HOMA index of surgery.Compared with the preoperative, postoperative blood groups, serum insulin concentrations before and HOMA-IR, HOMA-ISI was significantly higher than in patients(P<0.05), and HOMA-IS lower(P <0.05); the control group and after glucose load in patients with stress hyperglycemia was 35% & 5%(P <0.05); compared with the control group, blood glucose and glycemic load group were HOMA-IR were significantly lower than the control group(P< 0.05), HOMA-IS, HOMA-ISI was significantly higher(P <0.05). Conclusions:overall incidence of nosocomial hyperglycemia 19.2%, of which general surgery hospital hyperglycemia incidence rate of 15%, the highest incidence in the surgical department, presumably the reason many patients with general surgical emergency, perioperative stress hyperglycemia related to its stress including endogenous sex hormones(epinephrine, glucocorticoids, glucagon, etc.) increased production of cytokines(tumor necrosis factor, interleukin, etc.) release, and regulating the nervous system signals and the like. Applications QHS scoring system analysis hospital hyperglycemia control situation is not optimistic.In patients undergoing elective abdominal surgery and postoperative stress hyperglycemia incidence of 35%, surgery can lead to patient stress hyperglycemia, preoperative glycemic load can reduce the incidence of postoperative hyperglycemia(35% & 5 %, P <0.05). Preoperative glucose load application reduces the perioperative stress hyperglycemia incidence may be related to increasing insulin secretion and insulin sensitivity, reduce the degree of insulin resistance related.