| Objective:To investigate the morbidity of diabetes and hypertension amid the patients hospitalized in the general surgery department of part of Top Three Hospitals in Jiangsu province. To learn the glucose detection and management status of the patients with hyperglycemia during perioperative period who were hospitalized in the general surgery department, to discover the shortcomings of blood glucose management during perioperative period in order to raise the patients’ consciousness for blood glucose management during perioperative period in the hope of providing a new thought for the regulation of blood glucose for the patients during perioperative period.Methods:_The convenience sampling method was used to investigate the 3 top three general hospitals in Jiangsu Province as the research hospitals, which were Nanjing Gulou Hospital, provincial hospital of integrated traditional Chinese and Western medicine, Changzhou Hospital of Traditional Chinese Medicine, respectively. All of the patients admitted into these three hospitals in April, May and June in 2015 were registered in an inpatient list. Then a survey specific to the patients diagnosed as diabetes and non-diabetic patients who had a past history of fasting blood glucose more than 5.6mmol/L or a random blood glucose more than 7.8mmol/L was conducted by the use of survey case report form of blood glucose management for patients hospitalized in the general surgery department.Results:1, A total of 1618 cases of patients hospitalized in surgery department had been included into this survey, wherein there were 608 cases that accorded with diagnostic criteria of hyperglycemia, accounting for 37.6% of the total number of hospitalized patients, wherein, there were 230 cases of patients known to have diabetes upon admission, accounting for 14.2%. there were 24 cases newly diagnosed as diabetes by the diagnosis upon discharge, accounting for 1.5%. there were 354 cases of prediabetes, accounting for 21.9%.2, Amid the 608 cases of patient with hyperglycemia, there were 600 cases who received a biochemical detection for blood glucose(98.7%); there were 172 cases who received a peripheral blood glucose monitoring(28.3%); there were 276 cases who received a HbAlc detection(45.4%); there were 16 cases who received a OGTT detection(2.6%).3, Amid the 608 cases of patient with hyperglycemia, there were 474 cases of surgical patient, whose monitoring rate of preoperative peripheral blood glucose, HbAlc and OGTT were respectively 16.9%、20.7% and 4.2%, wherein, the cases where HbAlc<7% accounted for 30.6%. The monitoring rate of postoperative peripheral blood glucose, HbAlc and OGTT were respectively 24.9%、11.0% and 0.4%, wherein, the cases where HbAlc<7% accounted for 45.5%. The mean FBG on the day before, of and after surgery was respectively restricted to 7.3 ±2.1mmol/L,7.7±2.7mmol/L and 9.7±3.3mmol/L. On day 3 after surgery, the cases where the general control objective (FBG<8mmol/L) and loose control objective (FBG<10mmol/L) were achieved accounted for 67.7% and 84.7% respectively.4, Amid 474 cases of surgical patient, there were 80 cases who received a preoperative monitoring for peripheral blood glucose, there were 29 cases whose blood glucose was poorly controlled, there were 11 cases where a consultation of doctors from endocrinology department was required, with a consultation rate of 37.9%, there were 8 cases where the consultation advice was implemented; there were still 4 cases whose blood glucose was poorly controlled, wherein one case didn’t receive a follow-up treatment. There were 118 cases who received a postoperative monitoring for peripheral blood glucose, there were 33 cases whose blood glucose was poorly controlled after surgery, there were 9 cases where a consultation of doctors from endocrinology department was required with a consultation rate of 27.3%, there were 8 cases where the consultation advice was implemented, there were still 5 cases whose blood glucose was poorly controlled, wherein one case didn’t receive a follow-up treatment, accounting for 20%.5, Amid 474 cases of surgical patient, the cases where a therapy of lifestyle alone, oral medication alone, insulin alone and a combination of oral medication and insulin was applied respectively accounted for 61.4%、17.5%、13.1% and 8.0%; their pre-discharge counterparts were respectively 57.4%、10.3%、21.3% and 11.0%, wherein, the percentage of use of insulin went up by 11.2%.6, Amid 1618 cases of patient investigated in this survey, the difference in postoperative pulmonary infection (5.2%:11.0%) and incision infection (1.4%:3.6%) between the normal blood glucose group and hyperglycemia group was statistically significant (p<0.05), the difference in anastomotic fistula (0.8%:1.5%) and hyperglycemia reaction (1.4%:2.7%) was not statistically significant (p>0.05)7, Amid the 608 cases of patient with hyperglycemia, there were 474 cases who were performed with a surgery(77.9%), their average length of stay was 14.8±5.1 days, their average hospitalization expense was 24±12 thousand Yuan; there were 134 cases who didn’t receive a surgery(22.1%), their average length of stay was10.0±3.8 days, their average hospitalization expense was 13±5 thousand Yuan. Amid the surgical patients, the difference in length of stay and expense between the hyperglycemia group and normal blood glucose group was statistically significant(p<0.01). based on the FBG control level on day 3 after surgery, the patients were divided into four groups, the difference in length of stay and expense between the four groups was not statistically significant(p>0.05)8, Amid the doctor’s advice upon discharge of 608 cases of patient with hyperglycemia, there were 92 cases who were paid a follow-up visit from endocrinology department 15.1%); there were 32 cases who were diagnosed as diabetes and then transferred to another medical establishment(5.3%); there were 156 cases who received a doctor’s advice about blood glucose drug among 254 cases of patient who were definitely diagnosed as diabetes(61.4%); there were 71 cases of patient who had an access to syringe needle among 164 cases of patient who were treated with insulin(43.3%).Conclusion:1, The morbidity of diabetes and hyperglycemia were high among the patients hospitalized in the general surgery department of Top-three hospitals in Jiangsu province, a full-hospital blood glucose management is needed.2, The detection rate of peripheral blood glucose, HbAlc and OGTT was low among the patients with hyperglycemia hospitalized in the general surgery department. The understanding of importance of the detection for relevant indexes of patients with hyperglycemia by the surgeons needs to be improved.3, The detection rate of blood glucose during perioperative period was low among the patients with hyperglycemia hospitalized in the general surgery department; the blood glucose control level remains to be improved.4, The surgeons from the general surgery department did a good job to treat the hypoglycemia reaction of hospitalized patients with hyperglycemia during perioperative period, while what they did to treat hyperglycemia was very different from what was written in the guideline, the consultation rate of endocrinology department was low.5, The hyperglycemia raised the postoperative infection rate, prolonged the patients’length of stay and cost the patients more in hospitalization.6, the doctor’s advice upon discharge of general surgery department was deficient in The relevant management of blood glucose treatment, where a strengthened blood glucose management of patients discharged was required. |
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