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在使用-葡萄糖共运输体2抑制剂的患者中术后结果
Roberta Teixeira Tallarico1,2, Bocheng Jing3,4, Kaiwei Lu4
1Department of Anesthesia and Perioperative Care, University of California, San Francisco.
JAMA surgery
|April 30, 2025
概括
在手术前使用-葡萄糖共运输体2抑制剂 (SGLT2i) 略有增加了euglycemic ketoacidosis (eKA) 的风险,但降低了急性损伤 (AKI) 和手术患者30天死亡率的风险.
科学领域:
- 心脏病学和内分泌学.
- 科和重症监护中心
- 手术结果研究研究.
背景情况:
- -葡萄糖共运输体2抑制剂 (SGLT2i) 越来越多地用于2型糖尿病.
- 以前的研究表明,手术前使用SGLT2i和术后并发症,如euglycemic ketoacidosis (eKA) 和急性损伤 (AKI) 之间存在潜在的联系.
- 在大量的外科患者群体中,对这些风险进行全面评估是有必要的.
研究的目的:
- 在手术前使用SGLT2抑制剂 (SGLT2i) 的患者中评估术后euglycemic ketoacidosis (eKA),急性损伤 (AKI) 和30天死亡率的风险.
- 为了比较长期使用SGLT2i的用户和接受外科手术的非用户之间的这些结果.
主要方法:
- 一个多中心,回顾性,倾向匹配的病例控制研究,利用退伍军人事务医疗保健系统 (VAHCS) 国家注册 (2014-2022).
- 长期使用SGLT2i (按处方填充定义) 的成年患者的倾向性得分与基于人口统计学,并发症和外科特征的非使用者相匹配1:5.
- 主要结局是术后eKA;次要结局包括术后AKI和30天死亡率.
主要成果:
- 该研究包括7439名SGLT2i用户和33489名匹配的非用户.
- 使用SGLT2i与术后eKA风险显著增加有关 (OR,1.11;95% CI,1.05-1.17).
- 相反,SGLT2i的使用与术后AKI (OR,0.69;95%CI,0.62-0.78) 和30天死亡率 (OR,0.70;95%CI,0.55-0.88) 的风险降低有关,死亡率分别为1.1%和1.6%.
结论:
- 术前长期使用SGLT2i与术后euglycemic ketoacidosis (eKA) 的小但显著增加有关.
- 然而,SGLT2i的使用表明具有保护作用,降低了术后急性损伤 (AKI) 和30天死亡率的风险.
- 这些发现凸显了SGLT2i用户接受手术的复杂风险益处概况.
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