非心脏手术期间持续葡萄糖监测的准确性：一项前瞻性、盲法观察性多中心队列研究
贵州医科大学 麻醉与心脏电生理课题组
翻译：周倩 编辑：周倩 审校：曹莹
非心脏手术后高血糖在重症监护环境外很少被检测到，但实际发生频繁，且与感染和心肌损伤等超额并发症相关。目前缺乏关于在手术前即刻开始并贯穿整个围手术期早期的持续葡萄糖监测准确性的系统性前瞻性数据。本研究旨在评估最新一代持续葡萄糖监测系统在围手术期的可靠性。
方法
本研究前瞻性纳入年龄≥50岁、接受非心脏手术且需住院至少24小时的患者。使用实时持续葡萄糖监测系统（Dexcom G7传感器，置于上臂外侧）（美国加州圣地亚哥德康公司），参考值采用电流法测定的动脉血糖测量结果。主要结局是通过Bland-Altman分析评估术前、术毕和术后24小时的整体平均差异（偏差）。次要结局包括平均绝对相对差异和监测误差网格分析。
结果
在118名参与者中（64/118 [54%]为女性; 平均年龄：66岁[范围：51-89岁]；25%患有糖尿病），比较了三个预设时间点的配对血糖值。在麻醉诱导后最初24小时内，持续葡萄糖监测与血糖测量之间的总体偏差为0.38 mM（95% CI: 0.23-0.53；n=340次配对读数）。偏差从手术开始前的1.08 mM（95% CI: 0.87-1.29；n=116）降至术毕的0.15 mM（95% CI: -0.15-0.46；n=113）。平均绝对相对差异范围为12.0%至18.3%。误差网格分析显示，超过98%的持续葡萄糖监测值处于可接受风险范围内。
最新一代持续葡萄糖监测系统在非心脏手术围手术期使用安全，准确性足以用于临床，并可增强围手术期对血糖异常的监测。
原始文献：Janssen H, Dias P, Ahuja S, et al. Accuracy of continuous glucose monitoring during noncardiac surgery: a prospective, blinded observational multicentre cohort study. Br J Anaesth. 2025 Oct;135(4):912-919. doi: 10.1016/j.bja.2025.05.057. Epub 2025 Jul 24. PMID: 40707283.
Accuracy of continuous glucose monitoring during noncardiac surgery: a prospective, blinded observational multicentre cohort study
ABSTRACT
Background: Hyperglycaemia after noncardiac surgery is rarely detected outside of the critical care environment, yet occurs commonly and is associated with excess complications including infections and myocardial injury. Systematic, prospectively collected data regarding the accuracy of continuous glucose monitoring commenced immediately before surgery and throughout the early perioperative period are lacking.
Methods: We prospectively enrolled patients aged >50 yr undergoing noncardiac surgery who required at least 24 h of hospital stay. We used real-time continuous glucose monitoring (Dexcom G7 sensor, placed in the upper outer arm) (Dexcom, San Diego, CA, USA) with reference values from arterial blood glucose measurements by amperometry. The primary outcome was the overall mean difference (bias) before surgery, at end of surgery, and 24 h after surgery (Bland-Altman analysis). Secondary outcomes included the mean absolute relative difference and surveillance error grid analyses.
Results: We compared paired blood (73% arterial) and continuous glucose monitoring glucose values at each prespecified timepoint in 118 participants (64/118 [54%] female; mean age: 66 [range: 51-89] yr; 25% with diabetes mellitus). The overall bias between continuous glucose monitoring and blood glucose from measurements at each of the three timepoints in the first 24 h after induction of anaesthesia was 0.38 mM (95% confidence interval [95% CI]: 0.23-0.53; n=340 paired readings). Bias decreased from before the start of surgery (1.08 mM [95% CI: 0.87-1.29]; n=116) to 0.15 mM at the end of surgery (95% CI: -0.15 to 0.46; n=113). Mean absolute relative difference ranged from 12.0% to 18.3%. Error grid analyses found that >98% continuous glucose monitoring values were within acceptable risk ranges.
Conclusions: The accuracy of state-of-the-art continuous glucose monitoring is sufficient for perioperative use and could enhance perioperative surveillance of dysglycaemia.