术前合理管理对老年下肢骨折全麻手术患者血糖水平、血流动力学及应激因子的影响

摘要 目的：探讨术前合理管理对老年下肢骨折全麻手术患者血糖水平、血流动力学及应激因子的影响。方法：选择2017年6月-2019年6月我院收治的120例拟行全麻手术治疗的老年下肢骨折患者，随机分为两组。观察组（60例）给予术前合理管理，对照组（60例）给予传统术前管理。对比两组围术期血糖水平、血流动力学以及应激因子指标差异。结果：两组平均动脉压（MAP）、心输出量（CO）、体外循环阻力（SVR）、胸腔液体含量（TFC）、血糖、胰高血糖素、胰岛素、C肽、皮质醇 （Cor）、肾素（Rn）和促肾上腺皮质激素（ACTH）整体比较差异具有统计学意义（P＜0.05），观察组麻醉后或术后各时点MAP、CO、TFC、胰岛素、C肽高于对照组，SVR、血糖、胰高血糖素、Cor、Rn、ACTH低于对照组（P＜0.05）。观察组术后首次排气时间、首次下床活动时间、术后住院时间短于对照组（P＜0.05），口渴饥饿、术后感染发生率低于对照组（P＜0.05）。结论：术前合理管理可稳定老年下肢骨折全麻手术患者围术期血流动力学和血糖水平，降低应激因子水平和术后并发症风险，加快术后患者的康复。

Effects of Preoperative Management on Blood Glucose Level, Hemodynamics and Stress Factors in Elderly Patients Undergoing General Anesthesia for Lower Limb Fractures

ABSTRACT Objective: To investigate the effects of preoperative management on blood glucose level, hemodynamics and stress factors in elderly patients undergoing general anesthesia for lower limb fractures. Methods: From June 2017 to June 2019, 120 elderly patients with lower limb fractures who were admitted to the department of orthopedics of our hospital for general anesthesia operation were randomly divided into two groups. The observation group (60 cases) was given preoperative reasonable management, while the control group (60 cases) was given traditional preoperative management. The differences of blood glucose level, hemodynamics and stress factors were compared. Results: There were statistically significant differences between the two groups in mean arterial pressure (MAP), cardiac output (CO), systemic vascular resistance (SVR), thoracic fluid content (TFC), blood glucose, glucagon, insulin, C-peptide, cortisol(Cor), renin(Rn) and adrenocorticotrophic hormone (ACTH)(P<0.05). After anesthesia or surgery, MAP, CO, TFC, insulin and C-peptide were higher in the observation group than in the control group, while SVR, blood glucose, glucagon, Cor, Rn and ACTH were lower in the control group. The first postoperative exhaust time, first postoperative out-of-bed activity time and postoperative hospitalization time in the observation group were shorter than those in the control group(P<0.05). In the observation group, the first time to exhaust, the first time to get out of bed, the first time to stay in hospital were shorter than those in the control group(P<0.05), and the incidence of thirst, hunger and postoperative infection was lower than that in the control group(P<0.05). Conclusion: Preoperative reasonable management can stabilize perioperative hemodynamics and blood glucose level of elderly patients undergoing general anesthesia for lower limb fractures, reduce stress factor level and risk of postoperative complications, and promote rapid postoperative recovery.