甘精胰岛素用于2型糖尿病患者围手术期血糖控制的初步探讨

Perioperative Glycemic Control by Insulin Glargine in Type 2 Diabetic Patients

目的探讨使用甘精胰岛素进行2型糖尿病患者围手术期血糖控制的可行性。方法回顾性分析北京协和医院2004年9月～2006年7月采用甘精胰岛素行围手术期血糖控制的16例2型糖尿病患者(研究组)和采用胰岛素常规强化治疗方案的16例2型糖尿病患者(对照组)的资料。研究组患者在术前数日采用早7时甘精胰岛素加三餐前正规人胰岛素皮下注射进行强化治疗控制血糖;手术当日仍用原量甘精胰岛素注射,停用短效胰岛素;术后继续使用原量甘精胰岛素,视空腹血糖变化情况调整其剂量,患者如进食则于餐前给予短效胰岛素。对照组均采用传统胰岛素强化治疗方案进行术前准备,术后停用皮下胰岛素注射,改用静脉胰岛素输注;患者进食后可逐渐改回原胰岛素强化治疗方案。结果研究组患者在手术日与术后第1、2、3天的空腹血糖分别为(7.5±1.8)、(8.2±1.8)、(7.6±1.6)、(7.2±1.1)mmol/L,对照组患者空腹血糖分别为(9.0±2.8)、(10.4±2.4)、(8.8±2.7)、(9.0±2.0)mmol/L。研究组的空腹血糖在术后第1天和第3天显著低于对照组(P=0.02和0.01)。两组均无低血糖发生,伤口愈合良好。结论甘精胰岛素对2型糖尿病患者的围手术期血糖控制较为满意,低血糖发生可能性较小,具有安全、有效和方便的特点。

Objective To investigate the feasibility of perioperative glycemic control with insulin glargine in type 2 diabetic patients. betic inpatients treated with insulin Methods We retrospectively analyzed the clinical data of 16 type 2 diaglargine （research group） and 16 type 2 diabetic inpatients treated with the traditional intensified insulin therapy （ control group） for perioperative glycemic control. Results The fasting blood glucose values of the diabetic patients in the research group on the day of surgery and the first 3 postoperative days were （7.5±1.8）, （8.2±1.8）, （7.6 ±1.6）, and （7.2±1.1） mmoL/L, respectively, and were （9.0 ±2.8）, （ 10. 4 ±2.4）, （8.8 ±2.7）, （9.0 ±2. 0） mmoL/L in the control group, respectively.The fasting blood glucose values in the research group were significantly lower than the control group on the first and third postoperative day （P = 0.02 and 0.01, respectively）. No hypoglycemic events were observed and all wounds were healed well in both groups. Conclusion With satisfied fasting blood glucose level and fewer epi- sode of hypoglycemia, perioperative glycemic control by insulin glargine in type 2 diabetic patients is safe, effective, and convenient.