持续皮下胰岛素输注在伴有糖尿病的腹部大手术后危重患者肠外营养期间的应用

Application of continuous subcutaneous insulin infusion to diabetic patients after abdominal major operation during the time of total parenteral nutrition

目的 探讨持续皮下胰岛素输注在伴有糖尿病的腹部大手术后危重患者完全胃肠外营养期间的应用价值。方法 选择腹部大手术后行完全胃肠外营养（TPN）治疗1周（或以上）的伴有糖尿病的危重患者40例，随机分成两组：胰岛素泵持续皮下胰岛素输注（CSII）组和胰岛素盐水微量输液泵静脉持续输入组，分别监测血糖水平、低血糖发生以及切口感染和愈舍情况。结果 CSII组和对照组胰岛素应用后血糖均明显下降；治疗后第1天、第2天CSII组血糖控制情况明显优于对照组；治疗后第3—7天两组血糖比较无统计学意义；CSII组低血糖发生率、切口感染率、伤口愈合障碍率均低于对照组。结论 CSII控制腹部大手术后TPN支持期间伴有糖尿病危重患者的血糖，与传统静脉胰岛素滴注相比，血糖控制平稳，发生低血糖情况少，且可减少术后切口感染及愈合障碍等并发症，临床应用前景良好。

Objective To evaluate the value of the continuous subcutaneous insulin infusion in diabetic patients after abdominal major operation who were critical during the time of total parenteral nutrition. Method 40 case of diabetic patients after abdominal major operation were divided into 2 groups randomly ： one group received continuous subcutaneous insulin infusion （CSII ） with insulin pump and the other group received continuous insulin and saline input with microinfusion pump. All patients were treated with total parenteral nutrition （TPN） for 1 week or more. Plasma glucose, hypoglycemia incidence, the status of infection of incisional wound and intention were monitored. Results The plasma glucose in CSII and contlol group were significantly decreased; the plasma glucose of CSII was better than that of control group at the first day and the second day; and there wasnt significant difference from the third day to the seventh day. Hypoglycemia, infection of incisional wound and intention incidence rate of CSII were lower than those of control group. Conclusion CSII can imitate the insulin secretion pattern of pancreas. For diabetic patients after abdominal major operations who are critical during the time of total parenteral nutrition , CSII is better than traditional vein instillation in controlling plasma glucose, declining hypoglycemia incidence and the infection of incisional wound and healing barrier, the prospect of this method in clinical is very well.