术前使用SGLT2抑制剂和术后使用糖尿病酸性脂肪酸症
Anjali A Dixit1, Brian T Bateman1,2, Mary T Hawn3
1Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California.
JAMA surgery
|February 19, 2025
概括
在接受紧急手术的患者中,手术前使用-葡萄糖共运输体2抑制剂 (SGLT2i) 并没有增加糖尿病酸性脂肪酸症的风险. 这一发现表明,目前关于在手术前不服用SGLT2i药物的指导方针可能需要重新考虑.
科学领域:
- 内分泌学 在内分泌学.
- 手术护理 手术护理
- 药物监督 药物监督 药物监督
背景情况:
- 目前美国FDA的指导建议在手术前3天内停止服用-葡萄糖共传输体2抑制剂 (SGLT2i),因为有病例报告显示手术后患有糖尿病酸症.
- 在手术前停用SGLT2i药物可能会对糖尿病患者产生负面影响.
- 需要进行大规模评估,以评估与手术患者的SGLT2i使用相关的糖尿病酸性脂肪酸症风险.
研究的目的:
- 估计手术前SGLT2i药物使用与手术后糖尿病酸症风险之间的关联.
- 在接受各种紧急手术的患者中评估这种风险,假设他们可能无法根据当前指导方针保留药物.
主要方法:
- 一项回顾性队列研究,采用全国范围的18岁及以上2型糖尿病患者样本.
- 包括在2016年1月1日至2022年12月15日期间接受13项紧急手术中的1项的患者.
- SGLT2i药物使用是暴露,而手术后0-14天内的糖尿病酸性糖尿病是首要结局,由诊断代码定义.
主要成果:
- 该研究包括34671名接受紧急手术的患者;7.5%使用SGLT2i药物.
- 糖尿病酸症的发病率在SGLT2i组为4.9%,在未暴露组 (未调整) 中为3.5%.
- 在对共变量进行调整后,SGLT2i使用者的发病率为3.8%,非使用者的发病率为3.5%,平均治疗效果为0.2% (95% CI,-1.7%至2.2%),表明没有显著增加的风险.
结论:
- 在接受紧急手术的患者中,术前SGLT2i药物使用与术后糖尿病酸性酸症的风险增加无关.
- 这些发现可能支持重新考虑当前关于SGLT2i药物的术前禁用指南.
- 放宽这些准则可能会减轻接受手术的糖尿病患者的负面后果.
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