Effects Of Hypoxic Adaptation At High Altitude On Perioperative Blood Glucose Level During Hepatic Surgery

Objective:To explore the effect of highly altitude hypoxia adaptation on perioperative blood glucose level during liver surgery.Methods:The study was divided into two parts.The first part is a retrospective study that included patients who underwent partial hepatectomy at the Sichuan Academy of Medical Sciences-Sichuan Provincial People’s Hospital from December 2020 to December 2021.Perioperative data of patients undergoing liver surgery,including general information,routine preoperative tests,operative time,intraoperative access,postoperative test data,and postoperative complications,were recorded for statistical analysis.The second part was a real-world,prospective cohort study that included patients who underwent partial hepatectomy at the Sichuan Academy of Medical Sciences-Sichuan Provincial People’s Hospital from March 2022 to December 2022.Patients were divided into a high altitude group（living at an altitude≥1500m）and a low altitude group（living at an altitude<1500m）according to whether their permanent place of residence was above 1500m,and into a blocked and non-blocked group according to whether the liver surgery blocked blood flow to the liver..Intraoperative blood glucose concentrations were collected at various time points,and the trends in mean blood glucose levels over time and differences in blood glucose concentrations between the four subgroups,the high-altitude-blocked group（H-P group）,the low-altitude-blocked group（L-P group）,the high-altitude-non-blocked group（H-NP group）and the low-altitude-non-blocked group（L-NP group）,were statistically described.Results:In retrospective statistics,the difference in preoperative blood glucose concentration Glu[4.730（4.3,5.2）,4.920（4.5,5.5）,p=0.008]between the high and low altitude groups was statistically significant.In the prospective study,the liver surgery hepatic blood flow block group was compared to the non-hepatic blood flow block group at t₂[8.966±3.224,7.362±1.225,p=0.010]at the first hour after the start of surgery,t₃[11.262±2.855,7.706±1.424,p=0.003]at two hours after the start of surgery,and t4 at the third hour after the start of surgery[11.524±3.034,9.233±4.278,p=0.000]of blood glucose concentrations were statistically different.In the liver surgery hepatic blood flow block group,the high versus low altitude group had different blood glucose concentrations at the end of the first block at T₂[7.572±2.024,9.478±3.437,p=0.002],the end of the second block at T₃[9.505±2.305,11.839±2.795,p=0.000],and the end of the third block at T₄[9.676±2.711,12.161±3.016,p=0.000],and T₅[9.806±1.882,11.914±3.941,p=0.002]at the end of the fourth block were statistically different in blood glucose concentration.In addition,in a repeated measures ANOVA,the between-subjects effect was significant at 0.004,indicating that the between-subjects factor of altitude had a differential effect on blood glucose concentrations during liver surgery.Conclusion:In the retrospective study of liver surgery,patients in the high altitude group had lower preoperative and postoperative blood glucose concentrations than patients in the low altitude group.In liver surgery in the prospective study,blood glucose was significantly higher in the hepatic blood flow blocked group compared to the non-blocked group.In liver surgery with blocked hepatic blood flow,intraoperative blood glucose elevations were less in high-altitude patients than in low-altitude patients.There may be a stronger regulation of glucose homeostasis in high altitude populations and the mechanisms are still being explored.