| BackgroundStress hyperglycemia(SHG)is a state of insulin resistance(IR),impaired glucose tolerance or hyperglycemia resulting from acute and severe illness,trauma and perioperative stress.The effect of hyperglycemia on body includes chronically-elevated blood glucose and increased glycemic variability,which induces increased catabolism,negative nitrogen balance,poor healing and higher infection rate,thereby increasing mortality.Most of patients after pancreaticoduodenectomy(PD)still suffer from SHG on the seventh day after operation,since PD is one of the most invasive gastrointestinal surgery.Studies have shown that well management of blood glucose reduced postoperative complication and promoted the rehabilitation.Physical exercise after surgery help to maintain tension of the whole body muscles,and promote the metabolism of each system and blood circulation,which is beneficial to the regeneration and functional reconstruction of damaged tissues,thereby decreasing IR.Exercise plays an important role in decreasing blood glucose for patients with type 2 diabetes mellitus,where most scholars considers exercise intensity as a main factors affecting blood glucose,and moderate intensity is the first choice for well regulating blood glucose.Although exercise has been confirmed the efficacy of reducing inflammatory reaction and IR,there is no study quantitatively exploring the relationship between exercise intensity and time and SHG after PD.So this study aims to explore the efficacy of exercise intensity and time on SHG in patients after PD.Objectives1.The aim of the first part of this study was to confirm the intervention time for the next exercise program via retrospectively analyzing the blood glucose curve;2.The aim of this study was to investigate the quantitative relationship between exercise intensity and time and SHG after PD,in order to provide clinical nurses with predictive nursing and form an appropriate exercise prescription to maintain SHG.MethodsConsecutive non-diabetic patients undergoing PD in pancreas center in the First Affiliated Hospital of Nanjing Medical University between January 2015 and February 2016 were retrospectively included in current study.Blood values at 6:00,11:00,14:00,17:00,19:00,21:00 in patients after PD from the third day after surgery to the seventh day were collected,in order to paint the blood glucose curve and confirm the frequency and beginning time of exercise.The frequency and beginning time of exercise were confirmed in preceding retrospective study.Exercise was divided into two factors and two levels,where intensity was divided into lower and moderate level and exercise lasting time divided into 15 minutes and 30 minutes.Consecutive non-diabetic patients matched inclusion and exclusion standard undergoing PD in pancreas center in the First Affiliated Hospital of Nanjing Medical University between March 2016 and February 2017 were prospectively included in current study.Patients were randomly divided into 4 groups corresponding to related exercise program when meeting the condition of mobilization on the third day after PD.Blanked control group five was set up without exercise intervention where both the intensity and time were 0,and the cases were from the first part of this study.Demographic data,other information related to SHG,peripheral blood glucose at 6,11,17,21 o’clock during postoperative 7 days,fasting blood glucose(FBG)on postoperative day(POD)1,3 and 7,postoperative complication and postoperative length of hospital stay(LOS)were collected.The efficacy of exercise intensity and time on glycemic lability index(GLI),FBG and peripheral blood glucose,complication and postoperative LOS were compared.Results1.Results of the retrospective studyNinety-eight patients undergoing PD were collected in this study,and the results of analysis indicated that:The peak values of peripheral blood glucose each day from POD 3 to POD 7 appeared at 14 and 19 o’clock,and the curve of peripheral blood glucose came out low value at 17:00 and 21:00.The curve increased slower from 6:00 to 11:00 and rose faster from 11:00 until reaching the local peak value at 14:00.The beginning of exercise time was suggested to be half hours before the peak value according to literature review.So the exercise program was defined three times every day,and the beginning time was at 10:30,13:30,18:30 during POD 3 to POD 7.2.Results of intervention research(1)There were five groups,including low intensity-15 minutes,low intensity-30 minutes,moderate intensity-15 minutes,moderate intensity-30 minutes and blank group.The values of GLI in each group were 8.35±4.86,5.67±2.52,3.23±1.82,3.35.±2.25,8.02 ± 6.59(mmol/L)2 h-1·d-1.There was significance difference in the main effect of exercise intensity on GLI(F=11.091,P=0.001),and there was no significance difference in the main effect of exercise time and the interaction effect of exercise intensity and time on GLI(all P>0.05).There was significance difference in GLI between moderate intensity-15 minutes and blank group(P<0.05).(2)The values of FBG on POD 7 in each group were 6.74±1.68,6.34±0.84,6.24±1.34,6.61 ±1.00,7.36 ± 1.06,mmol/L,there was no significant different in main and interaction effect of exercise intensity and time(all P>0.05).Low intensity,moderate intensity,15 minutes and 30 minutes of FBG on POD 7 was significant lower compared with blank group(all P<0.05).(3)The values of average peripheral blood glucose each day from POD 3 to POD 7 were 9.03±1.47,8.61±1.05,8.08±1.16,8.77±1.09,9.95 ± 2.12 mmol/L,there was no significant different in main and interaction effect of exercise intensity and time(all P>0.05).Low intensity,moderate intensity,15 minutes and 30 minutes of peripheral blood glucose from POD 3 to POD 7 was significant lower compared with blank group(all P<0.05).(4)There was no significant different in postoperative complication and postoperative LOS in each group(all P>0.05).ConclusionsExercise intervention can regulate SHG.Exercise intensity played the role of the main effect on GLI considering the efficacy of exercise intensity and time on SHG.Exercise time should last 30 minutes when patients after PD walk under lower intensity;while patients under moderate exercise reaching 15 minutes could effectively control glycemic variability.Exercise with moderate intensity-15 minutes was the best program of all for reducing the glycemic variability in patients after PD without increasing the rate of postoperative complication,which deserved to be popularized in clinic. |
PDF Full Text Request