儿童术中低血糖的危险因素：回顾性观察性队列研究

背景：术中低血糖如果不及时诊断和治疗，会导致神经系统严重损伤。目前关于术中低血糖危险因素的研究较少。本研究旨在分析发生术中低血糖的患儿特征，并明确发生术中低血糖的独立危险因素。

方法：本研究纳入了从2012年1月1日至2016年12月31日期间所有接受麻醉的18岁以下患儿。主要指标是血糖<3.3mmol·L^-1（60 mg·dl^-1）。收集的数据包括患者特征、合并症和术中因素。多变量Logistic模型用于检测术中低血糖的独立预测因素。

结果：73592例患儿中有7715例测量了血糖，其中271例（3.5％）患儿的血糖<3.3mmol·L^-1（60 mg·dl^-1）。年幼、体重小于同龄患儿的第5百分位数、发育迟缓、留置胃管或空肠管以及腹部手术被认为是术中发生低血糖的独立预测因素。80％的低血糖病例发生在＜3岁和体重＜15 kg的患儿中。

结论：年幼、体重小于同龄患儿的第5百分位数、发育迟缓、留置胃管或空肠管以及腹部手术是儿童术中发生低血糖的独立危险因素。这些儿童可能需要频繁监测血糖并适当输注等渗葡萄糖溶液。

文献来源：  Riegger LQ, Leis AM, Malviya S,et,al.Risk factors for intraoperative hypoglycemia in children: a retrospective observational cohort study.[J].Can J Anaesth, 2020;02,27(2).

Risk factors for intraoperative hypoglycemia in children: a retrospective observational cohort study

AbstractPURPOSE:Intraoperative hypoglycemia can result in devastating neurologic injury if not promptly diagnosed and treated. Few studies have defined risk factors for intraoperative hypoglycemia. The authors sought to characterize children with intraoperative hypoglycemia and determine independent risk factors.

METHODS:This retrospective observational single-institution study included all patients < 18 yr of age undergoing an anesthetic from January 1 2012 to December 31 2016. The primary outcome was blood glucose < 3.3 mmol·L^-1(60 mg·dl^-1). Data collected included patient characteristics, comorbidities, and intraoperative factors. A multivariable logistic regression model was used to identify independent predictors of intraoperative hypoglycemia.

RESULTS:Blood glucose was measured in 7,715 of 73,592 cases with 271 (3.5%) having a glucose < 3.3 mmol·L^-1 (60 mg·dl^-1). Young age, weight for age < 5th percentile, developmental delay, presence of a gastric or jejunal tube, and abdominal surgery were identified as independent predictors for intraoperative hypoglycemia. Eighty percent of hypoglycemia cases occurred in children < three years of age and in children < 15 kg.

CONCLUSION:Young age, weight for age < 5th percentile, developmental delay, having a gastric or jejunal tube, and abdominal surgery were independent risk factors for intraoperative hypoglycemia in children. Frequent monitoring of blood glucose and judicious isotonic dextrose administration may be warranted in these children.