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胰腺切除术期间的低血压与手术后糖尿病的发展之间的关联
Seoil Moon1, Mirang Lee2, Jun Suh Lee3
1Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul National University Hospital, Seoul 03080, Korea.
The Journal of clinical endocrinology and metabolism
|April 8, 2024
概括
在胰腺切除术期间的手术内低血压会增加患糖尿病的风险. 这种低血压可能导致β细胞不足,影响手术后的血糖控制.
科学领域:
- 内分泌学 在内分泌学.
- 手术瘤学手术瘤学
- 代谢疾病 代谢疾病
背景情况:
- 胰腺切除术后的糖尿病是一个新兴的问题,随着长期生存率的增加.
- 胰腺切除术后糖尿病的危险因素在很大程度上仍未被定义.
- 胰腺小岛对缺血性损伤的敏感性需要临床研究.
研究的目的:
- 为了研究手术内低血压和胰腺切除术后糖尿病的发展之间的关联.
- 为了探索低血压对胰腺手术后血糖控制的影响.
主要方法:
- 在2005年至2018年期间,对1129名接受胰腺切除术 (远程或胰腺双切除术) 的患者进行了回顾性纵向队列研究.
- 术内低血压定义为缩性血压降低≥20%.
- 主要结局:发生糖尿病;次要结局:手术后的恒温模式评估 (HOMA) 指数.
主要成果:
- 83%的患者经历了手术内低血压 (IOH).
- 在平均3.9年的随访期间,25%的患者患上糖尿病.
- 增加IOH的持续时间和深度与较高的糖尿病发病率显著相关 (中位持续时间HR为1.48).
- IOH持续时间与1年的HOMAβ细胞功能相反相关,但不是胰岛素耐药性.
结论:
- 在胰腺切除术期间的手术内低血压是患胰腺切除术后糖尿病的重要危险因素.
- 低血压可能通过诱导胰腺β细胞缺乏导致糖尿病的发展.
- 这些发现强调了在胰腺手术期间保持血液动力学稳定的重要性.
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