Effect of intraoperative glucose fluctuation and postoperative IL-6, TNF-α, CRP levels on the short-term prognosis of patients with intracranial supratentorial neoplasms.

Objective: To investigate the effect of intraoperative glucose fluctuation and postoperative interlukin-6 (IL-6), tumor necrosis factor-α (TNF-α), C-reactive protein (CRP) levels on the short-term prognosis of patients with intracranial supratentorial neoplasms.

Materials And Methods: Eighty-six patients undergoing intracranial excision were selected in The Second Hospital of Jilin University. According to the condition of glucose fluctuation, the patients were divided into group A (glucose fluctuation <2.2 mmol/L, n=57) and group B (glucose fluctuation ≥2.2 mmol/L, n=29). Glucose was assessed by drawing 2 mL blood from internal jugular vein in two groups in the following time points, namely fasting blood glucose 1 d before operation (T0), 5 min after anesthesia induction (T1), intraoperative peak glucose (T2), intraoperative lowest glucose (T3), 5 min after closing the skull (T4), immediately after returning to intensive care unit (ICU) (T5) and 2 h after returning to ICU (T6). 1 d before operation and 1, 3 and 6 d after operation, serum IL-6 and TNF-α levels were detected with enzyme-linked immunosorbent assay (ELISA), and CRP level with immunoturbidimetry. Additionally, postoperative adverse reactions were monitored.

Results: There was no statistical significance between two groups regarding the operation time, anesthesia time, amount of intraoperative bleeding and blood transfusion (P>0.05). The glucose levels in both groups at T1~T6 went up conspicuously compared with that at T0 (P<0.01), and those in group B at T2, T4, T5 and T6 were significantly higher than in group A (P<0.01). Serum IL-6, TNF-α and CRP levels in both groups 1, 3 and 6 d after operation increased markedly compared with 1 d before operation (P<0.01), but the increased range in group A was notably lower than in group B (P<0.05 or P<0.01). Postoperative incidences of hypoglycemia, hyperglycemia and myocardial ischemia in group A were significantly lower than in group B (P<0.05), and respiratory support time obviously shorter than in group B (P<0.01).

Conclusions: The glucose fluctuation of patients undergoing intracranial excision is related to postoperative IL-6, TNF-α and CRP levels and those with small range of glucose fluctuation have better prognosis.