糖尿病患者围手术期用胰岛素泵控制血糖的临床观察

Perioperative Glucose Control by Insulin Pump Therapy in Diabetics Patients

目的:探讨胰岛素泵对糖尿病患者围手术期控制血糖的疗效。方法:对78例择期手术的糖尿病患者分别应用胰岛素泵持续皮下输注胰岛素(CSII组,37例)和常规皮下注射胰岛素(对照组,41例)控制血糖。另外13例急诊手术者均行CSII控制血糖。结果:择期手术中,CSII组入院时空腹血糖(FBG)15.3±2.4mmol.L-1,餐后2h血糖(PG2h)19.6±4.1mmol.L-1,糖化血红蛋白(HbA1c)9.02±2.12%。对照组入院时FBG14.3±2.68mmol.L-1,PG2h19.2±3.2mmol.L-1,HbA1c8.93±1.98%。两组方法均能显著降低空腹以及餐后血糖,与对照组比较,CSII组血糖达标时间、胰岛素用量均有显著性差异(P<0.05),CSII组能更迅速控制血糖。另外还有13例急诊手术者通过随时血糖监测调整基础率以及临时给予大剂量冲击后,血糖在数小时内由18.13±3.56mmol.L-1下降到可接受手术的血糖水平(8～10mmol.L-1)。除2例出现低血糖先兆经对症处理后缓解外,无一例发生低血糖昏迷、酮症酸中毒、高渗性昏迷等严重并发症。结论:与常规皮下注射胰岛素相比,胰岛素泵治疗对围手术期糖尿病患者具有平稳、快速、安全降低血糖的作用。

Objective：To investigate the effects with continuous subcutaneous insulin injection （CSII） in diabetic patients during perioperation. Methods： During perioperation 37 diabetic patients used CSII （CSII group）and 41 cases used subcutaneous in sulin injection（control group） to control blood glucose. The other 13 emergency patients＇ blood glucose were decreased with CSII. Results： InCSII group, before operation, FBG15.3±2.4 mmol · L^-1,pG2h 19.6±4.1 mmol · L^-1, HbAlc 9. 02 ± 2.12 % ;In control group, FBG 14.3 ± 2.68 mmol· L^-1 ,PG2h 19.2 ± 3.2 mmol · L^-1 ,HbAlc 8.93 ± 1.98% ,all patients were elective surgery. Both methods were able to significantly reduce FBG and PG2h. In contrast with control group, CSII group achieves the goal of blood glucose control rapidly and required significantly less insulin dosage （P〈0. 05）. The other 13 emergency patients＇ blood glucose were reduced from 18. 13± 3.56 mmol · L^-1 to 84 10 mmol · L^-1 in several hours with CSII. There was no hypoglycemic coma, ketoacidosis, hyperosmolar coma, and other serious complications. Conclusion：The optimal glyeemic control in diabetic patients during perioperation was acquired more rapidly and stably by CSII than control.