Abstract

Purpose

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.

中文翻译：

---

儿童术中低血糖的危险因素：一项回顾性观察队列研究

摘要

目的

如果不及时诊断和治疗，术中低血糖会导致毁灭性神经损伤。很少有研究确定术中低血糖的危险因素。作者试图描述术中低血糖的患儿特征，并确定独立的危险因素。

方法

该回顾性观察性单机构研究纳入了从2012年1月1日至2016年12月31日接受麻醉的所有18岁以下的患者。主要结果是血糖<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回归模型用于确定术中低血糖的独立预测因子。

结果

在73,592例病例中的7,715例中，有271例（3.5％）血糖＜3.3mmol·L ^-1（60 mg·dl ^-1）被测出血糖。年轻，年龄小于5个百分点的体重，发育迟缓，胃管或空肠管的存在以及腹部手术被确定为术中低血糖的独立预测因子。80％的低血糖病例发生在3岁以下的儿童和15 kg以下的儿童中。

结论

年龄小，体重<5％的体重，发育迟缓，有胃管或空肠管以及腹部手术是儿童术中低血糖的独立危险因素。这些儿童可能需要经常监测血糖和明智的等渗葡萄糖给药。