刘志新 刘志奎 张越 王敬

摘   要：目的  观察腰椎管狭窄症伴糖尿病患者术后21 d内的血糖变化，以探讨腰椎管狭窄症伴糖尿病患者术后血糖变化规律及影响因素。方法  前瞻性收集開滦总医院自2015年7月～2017年7月腰椎管狭窄症椎板切除减压植骨融合术患者49例，按照前瞻性队列研究，根据患者是否患2型糖尿病分为糖尿病组21例和非糖尿病组28例，空腹静脉采血监测手术前和术后3周内（1 d、3 d、7 d、14 d、21 d）患者空腹血糖变化情况。结果  糖尿病组和非糖尿病组在术后第1天血糖值分别为（12.22±1.35）mmol/L、（5.60±0.29）mmol/L，3 d血糖下降至（11.03±1.27）mmol/L、（5.26±0.29）mmol/L，7～14 d恢复到术前水平，为（7.82±1.08）mmol/L、（4.77±0.31）mmol/L，21 d为（7.04±1.08）mmol/L、（4.67±0.31）mmol/L。两组时间点、组别以及时间点和组别交互作用对血糖的影响均有统计学意义（P<0.05）。结论  腰椎管狭窄症伴糖尿病患者，术后空腹血糖波动较大，手术的应激和患者本身运动消耗等原因是造成血糖波动的主要原因。

关键词：腰椎管狭窄症;腰椎PLF术;空腹血糖

中图分类号：R687.3                               文献标识码：A                                   DOI：10.3969/j.issn.1006-1959.2018.16.020

文章编号：1006-1959（2018）16-0072-04

Changes of Fasting Blood Glucose after Lumbar PLF Operation

LIU Zhi-xin1，LIU Zhi-kui1，ZHANG Yue1，WANG Jing2

（1.Department of Orthopedics，Kailuan General Hospital Affiliated to North China Polytechnic University，Tangshan 063000，Hebei，China;2.Hebei Yanda Hospital，Langfang 065000，Hebei，China）

Abstract：Objective  To observe the changes of blood glucose in patients with lumbar spinal stenosis and diabetes mellitus within 21 d after operation，so as to explore the changes of blood glucose and its influencing factors in patients with lumbar spinal stenosis and diabetes mellitus.Methods  49 patients with lumbar spinal stenosis underwent laminectomy，decompression and bone graft fusion from July 2015 to July 2017 in Kailuan General Hospital were prospectively collected.According to the prospective cohort study，patients with type 2 diabetes were divided into diabetes group（21 cases）and non-diabetes group（28 cases）.The changes of fasting blood glucose were monitored before operation and within 3 weeks after operation（1d，3d，7d，14d，21d）.Results  On the first day after operation，the blood glucose levels in diabetic group and non-diabetic group were（12.22±1.35）mmol/L，（5.60±0.29）mmol/L，the blood glucose dropped to（11.03+1.27）mmol/L，（5.26+0.29）mmol/L on the 3 d.From 7 to 14th d，it returned to the preoperative level，which was（7.82±1.08） mmol/L，（4.77±0.31）mmol/L，and（7.04±1.08）mmol/L，（4.67±0.31）mmol/L on 21 d.The influence of time point，group，time point and group interaction on blood glucose was statistically significant（P<0.05）.Conclusion  In patients with lumbar spinal stenosis and diabetes mellitus，fasting blood glucose fluctuates greatly after operation.The main causes of blood glucose fluctuate are surgical stress and exercise expenditure.

Key words：Lumbar spinal stenosis;Lumbar PLF;Fasting blood glucose

腰椎管狭窄症（lumbar spinal stenosis，LSS）系腰椎管的中央、侧隐窝或椎间孔狭窄引起腰神经受压症状的疾病。腰椎管狭窄主要原因包括椎间盘退变、小关节退变、小关节增生、椎板增厚、椎体后唇骨赘增生入椎管等，多好发于老年人，而老年2型糖尿病的发病率为20%以上[1]，故多数腰椎管狭窄症的患者常伴有糖尿病。国内一些学者报道[2-5]，因血糖控制不佳，术后常常出现切口脂肪液化、渗出、感染及切口愈合不良等现象，影响了手术效果。针对此现象，课题组前瞻性收集了我科2015年7月～2017年7月腰椎管狭窄椎板切除植骨融合术患者临床资料，通过对腰椎管狭窄症术后3周内血糖的动态观察，了解腰椎管狭窄症术后21 d内血糖变化规律和影响因素，提高手术疗效、干预术后并发症发生。……