术后早期应激性高血糖对非2型糖尿病胃癌病人术后并发症影响研究

程一帆; 田震; 周家杰; 李瑞奇; 赵帅; 王杰; 伏亚彦; 孙倩男; 王道荣

doi:10.19538/j.cjps.issn1005-2208.2026.04.22

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中国实用外科杂志 ›› 2026, Vol. 46 ›› Issue (4) : 516-521. DOI: 10.19538/j.cjps.issn1005-2208.2026.04.22

论著

术后早期应激性高血糖对非2型糖尿病胃癌病人术后并发症影响研究

程一帆 ¹^,²^,³ ,
田震 ¹^,²^,³ ,
周家杰 ¹^,²^,³ ,
李瑞奇 ¹^,²^,³ ,
赵帅 ¹^,²^,³ ,
王杰 ²^,³ ,
伏亚彦 ²^,³ ,
孙倩男 ²^,³ ,
王道荣 ¹^,²^,³

作者信息 +

The impact of early postoperative stress hyperglycemia on postoperative complications in non-type 2 diabetic patients with gastric cancer

CHENG Yi-fan ¹^,²^,³ ,
TIAN Zhen ¹^,²^,³ ,
ZHOU Jia-jie ¹^,²^,³ ,
LI Rui-qi ¹^,²^,³ ,
ZHAO Shuai ¹^,²^,³ ,
WANG Jie ²^,³ ,
FU Ya-yan ²^,³ ,
SUN Qian-nan ²^,³ ,
WAGN Dao-rong ¹^,²^,³

Author information +

文章历史 +

摘要

目的探讨术后早期应激性高血糖（SHG）对无2型糖尿病病史胃癌病人术后并发症的影响，并分析血糖峰值及SHG持续时间与预后的关系。方法回顾性分析2022年1月至2024年3月苏北人民医院胃肠外科收治的行腹腔镜胃癌根治术的455例无2型糖尿病病史胃癌病人的临床资料。根据术后是否发生SHG分为SHG组（113例）和非SHG组（342例）。比较两组术后并发症发生率及严重程度，并采用多因素Logistic回归分析独立危险因素，同时对SHG病人按血糖峰值（≤14.0 mmol/L和>14.0 mmol/L）及持续时间（持续1 d、持续2 d、持续3 d）进行分层分析。结果 SHG组术后并发症发生率显著高于非SHG组（46.9% vs. 23.1%，P<0.001）。多因素分析结果显示，年龄（OR=2.262，P=0.002）、手术时间（OR=1.876，P=0.005）及SHG（OR=2.355，P=0.004）为术后并发症的独立危险因素。SHG组切口感染、肺部感染、肠梗阻及吻合口漏发生率显著增高（P<0.05）。进一步分析结果显示，血糖峰值≥14.0 mmol/L病人术后并发症风险增加（χ²=8.246，P=0.004），且Ⅲ级并发症发生率升高（χ²=5.262，P=0.022）；在发生SHG的病人中，按SHG持续时间分层的术后并发症发生率差异有统计学意义（χ²=25.862，P<0.001）。结论术后早期SHG是无2型糖尿病病史胃癌病人术后并发症的独立危险因素。重度高血糖及SHG持续时间延长导致并发症发生风险增高，故围手术期血糖管理应同时关注血糖水平和持续时间。

Abstract

Objective To investigate the impact of early postoperative stress hyperglycemia (SHG) on postoperative complications in gastric cancer patients without a history of type 2 diabetes mellitus, and to analyze the associations of peak blood glucose level and SHG duration with prognosis. Methods A retrospective analysis was conducted on the clinical data of 455 gastric cancer patients without a history of type 2 diabetes mellitus who underwent laparoscopic radical gastrectomy at the Department of Gastrointestinal Surgery, Northern Jiangsu People’s Hospital, between January 2022 and March 2024. According to whether SHG occurred after surgery, the patients were divided into a SHG group (n=113) and a non-SHG group (n=342). The incidence and severity of postoperative complications were compared between the two groups, and multivariate logistic regression analysis was used to identify independent risk factors. In addition, SHG patients were stratified according to peak blood glucose level and duration of SHG for further analysis. Results The incidence of postoperative complications was significantly higher in the SHG group than in the non-SHG group (46.9% vs. 23.1%, P<0.001). Multivariate analysis showed that age (OR=2.262, P=0.002), operation time (OR=1.876, P=0.005), and SHG (OR=2.355, P=0.004) were independent risk factors for postoperative complications. The incidences of incision infection, pulmonary infection, intestinal obstruction, and anastomotic leakage were significantly higher in the SHG group (P<0.05). Further analysis showed that patients with peak blood glucose ≥14.0 mmol/L had a higher risk of postoperative complications (χ²=8.246, P=0.004) and a higher incidence of grade III complications (χ²=5.262, P=0.022). Among patients with SHG, the incidence of postoperative complications differed significantly among groups with different SHG durations (χ²=25.862, P<0.001). Conclusion Early postoperative SHG is an independent risk factor for postoperative complications in gastric cancer patients without a history of type 2 diabetes mellitus. Severe hyperglycemia and prolonged SHG duration are associated with an increased risk of complications. Therefore, perioperative blood glucose management should focus on both glucose level and duration.

导出引用

程一帆, 田震, 周家杰, 等. 术后早期应激性高血糖对非2型糖尿病胃癌病人术后并发症影响研究[J]. 中国实用外科杂志. 2026, 46(4): 516-521 https://doi.org/10.19538/j.cjps.issn1005-2208.2026.04.22

CHENG Yi-fan, TIAN Zhen, ZHOU Jia-jie, et al. The impact of early postoperative stress hyperglycemia on postoperative complications in non-type 2 diabetic patients with gastric cancer[J]. Chinese Journal of Practical Surgery. 2026, 46(4): 516-521 https://doi.org/10.19538/j.cjps.issn1005-2208.2026.04.22

中图分类号： R6

参考文献

列表( 原文顺序 | 文献年度倒序 | 文中引用次数倒序 ) 可视化分析

[1]	Shouman M, Brabant M, Rehman N, et al. Perioperative management of patients with diabetes and cancer: Challenges and opportunities[J]. Cancers (Basel), 2024, 16(16):2821. DOI: 10.3390/cancers16162821. 本文引用 [1]

[2]	Shah NJ, Leis A, Kheterpal S, et al. Association of intraoperative hyperglycemia and postoperative outcomes in patients undergoing non-cardiac surgery: A multicenter retrospective study[J]. BMC Anesthesiol, 2020, 20(1): 106. DOI: 10.1186/s12871-020-01022-w. 本文引用 [1]

[3]	Dungan KM, Braithwaite SS, Preiser JC. Stress hyperglycaemia[J]. Lancet, 2009, 373(9677): 1798-1807. DOI: 10.1016/s0140-6736(09)60553-5. 本文引用 [1]

[4]	Ali Abdelhamid Y, Kar P, Finnis ME, et al. Stress hyperglycaemia in critically ill patients and the subsequent risk of diabetes: A systematic review and Meta-analysis[J]. Crit Care, 2016, 20(1): 301. DOI: 10.1186/s13054-016-1471-6. 本文引用 [1]

[5]	Abdu FA, Galip J, Qi P, et al. Association of stress hyperglycemia ratio and poor long-term prognosis in patients with myocardial infarction with non-obstructive coronary arteries[J]. Cardiovasc Diabetol, 2023, 22(1): 11. DOI: 10.1186/s12933-023-01742-6. 本文引用 [1]

[6]	Dolp R, Rehou S, Pinto R, et al. The effect of diabetes on burn patients: a retrospective cohort study[J]. Crit Care, 2019, 23(1): 28. DOI: 10.1186/s13054-019-2328-6. 本文引用 [2]

[7]	Japanese Gastric Cancer Association. Japanese Gastric Cancer Treatment Guidelines 2021 (6th edition)[J]. Gastric Cancer,2023, 26(1): 1-25. DOI: 10.1007/s10120-022-01331-8. 本文引用 [1]

[8]	American Diabetes Association. Classification and diagnosis of diabetes: standards of medical care in diabetes-2020[J]. Diabetes Care, 2020, 43(suppl1):14-31. DOI: 10.2337/dc20-S002. 本文引用 [2]

[9]	Collins SL, Moore RA, McQuay HJ. The visual analogue pain intensity scale: what is moderate pain in millimetres?[J]. Pain, 1997, 72(1-2): 95-97. DOI: 10.1016/s0304-3959(97)00005-5. 本文引用 [1]

[10]	van Cromphaut SJ. Hyperglycaemia as part of the stress response: The underlying mechanisms[J]. Best Pract Res Clin Anaesthesiol, 2009, 23(4): 375-386. DOI: 10.1016/j.bpa.2009.08.005. 本文引用 [1]

[11]	Duggan E, Chen Y. Glycemic management in the operating room: screening,monitoring,Oral Hypoglycemics,and Insulin Therapy[J]. Curr Diab Rep, 2019, 19(11): 134. DOI: 10.1007/s11892-019-1277-4. 本文引用 [1]

[12]	夏海娜, 牛桂林, 历冰, 等. 非糖尿病胃癌病人手术应激性高血糖对术后感染及预后的影响分析[J]. 中华医院感染学杂志, 2017, 27(12): 2740-2743. DOI: 10.11816/cn.ni.2017-163557. 本文引用 [1]

[13]	Clayton SM, Shafikhani SH, Soulika AM. Macrophage and neutrophil dysfunction in diabetic wounds[J]. Adv Wound Care(New Rochelle), 2024, 13(9): 463-484. DOI: 10.1089/wound.2023.0149. 本文引用 [1]

[14]	Jafar N, Edriss H, Nugent K. The effect of short-term hyperglycemia on the innate immune system[J]. Am J Med Sci, 2016, 351(2): 201-211. DOI: 10.1016/j.amjms.2015.11.011. 本文引用 [1]

[15]	Akimoto E, Kinoshita T, Sato R, et al. Impact of postoperative intra-abdominal infectious complications on survival outcomes in patients with gastric cancer who underwent laparoscopic surgery[J]. Surg Endosc, 2023, 37(1): 382-390. DOI: 10.1007/s00464-022-09522-1. 本文引用 [1]

[16]	Fiorillo C, Rosa F, Quero G, et al. Postoperative hyperglycemia in nondiabetic patients after gastric surgery for cancer: perioperative outcomes[J]. Gastric Cancer, 2017, 20(3):536-542. DOI: 10.1007/s10120-016-0621-5. 本文引用 [1]

[17]	中华医学会外科学分会, 中华医学会麻醉学分会. 中国加速康复外科临床实践指南(2021版)[J]. 中国实用外科杂志, 2021, 41(9): 961-992. DOI:10.19538/j.rjps.issn1005-2208.2021.09.01. 本文引用 [1]

[18]	Mieczkowski M, Mrozikiewicz-Rakowska B, Kowara M, et al. The problem of wound healing in diabetes-from molecular pathways to the design of an animal model[J]. Int J Mol Sci, 2022, 23(14):7930. DOI: 10.3390/ijms23147930. 本文引用 [1]