术前血糖管理和术后认知功能相关性的研究进展

Research Progress on the Correlation between Preoperative Blood Glucose Management and Postoperative Cognitive Function

摘要: 术前血糖水平的监测，对于指导其术前血糖调整、降低术前应激、安全度过围术期，减少术后相关并发症的发生，对老年合并2型糖尿病(Type 2 Diabetes, T2DM)患者是尤为重要的。血糖监测是糖尿病管理的重要内容，其结果可以反映糖尿病患者糖代谢紊乱的程度。临床常用的血糖监测指标包括指尖毛细血管血糖监测、糖化血红蛋白(glycated hemoglobin A1c, HbA1c)、糖化白蛋白(glycatedalbumin, GA)、果糖胺(fructosamine, FA)和持续葡萄糖监测(continuous glucose monitoring, CGM)等。静脉血浆葡萄糖反映了瞬时的血糖值，其受饮食、环境、应激状态和药物使用等影响，导致其变异性大的特点，且无法判断长期血糖的控制水平。一些临床研究探讨了糖尿病患者术前血糖控制与术后认知功能障碍(postoperative cognitive dysfunction, POCD)之间的关联。术前血糖控制水平对术后认知功能并发症的影响的研究结果不尽相同。本文对近年来术前血糖管理对术后认知功能并发症的影响做一综述，为减少术后并发症的发生，使患者有更好的转归，以期为围术期管理提供参考。

Abstract: Preoperative blood glucose monitoring is particularly important for elderly patients with Type 2 Diabetes (T2DM) to guide preoperative blood glucose adjustment, reduce preoperative stress, safe-ly pass the perioperative period, and reduce the occurrence of postoperative complications. Blood glucose monitoring is an important part of diabetes management, and its results can reflect the de-gree of glucose metabolism disorder in diabetic patients. Commonly used clinical blood glucose monitoring indexes include fingertip capillary blood glucose monitoring, glycated hemoglobin (he-moglobin 1c, HbA1c), glycated albumin (GA), fructosamine (FA) and continuous glucose monitoring (CGM). Intravenous plasma glucose reflects the instantaneous blood glucose value, which is affected by diet, environment, stress state and drug use, leading to its characteristics of great variability, and it is impossible to judge the long-term blood glucose control level. Some clinical studies have explored the correlation between preoperative glycemic control and postoperative cognitive dys-function (POCD) in diabetic patients. The effects of preoperative blood glucose control on postopera-tive cognitive function complications have varied results. This paper reviews the influence of pre-operative blood glucose management on postoperative cognitive function complications in recent years, in order to reduce the occurrence of postoperative complications, enable patients to have a better outcome and provide reference for perioperative management.