胰腺癌合并糖尿病的围手术期处理

Perioperative management of associated diabetes mellitus in Pancreatic cancer patients

目的探索胰腺癌合并糖尿病患者围手术期血糖控制的安全方法。比较胰岛素两种疗法对胰腺癌合并糖尿病患者围手术期治疗效果。方法对40例胰腺癌合并糖尿病患者围手术期治疗进行回顾性分析,其中18例采用多次皮下胰岛素注射(MSII)给药方式,22例应用胰岛素泵(CSII)连续皮下给药。结果两种疗法均能有效控制胰腺癌合并糖尿病患者围手术期血糖。胰岛素泵连续注射比多次注射血糖达标时间短[CSI(I5.20±1.20)dvsMSI(I9.02±3.16)d,P<0.05)],低血糖发生率低(CSII13.18%vsMSII22.22%,P<0.05),术中及术后未进食阶段血糖波动小[CSI(I5.67±1.36)vsMSI(I7.52±4.18),P<0.05)],术后并发感染和切口愈合不良并发症少(CSII4.55%vsMSII16.67%,P<0.05)。结论两种疗法均能有效控制胰腺癌合并糖尿病患者围手术期血糖。CSII比MSII更快更有效地控制高血糖,并减少低血糖和感染的发生率。

【Objective】To determine the safe method of perioperative glycemic control in diabetic patients during Pancreatic cancer surgery and to compare the treating effect between two insulin use in controlling blood glucose. 【Methods】40 cases with pancreatic cancer and diabetes mellitus underwent operation from 1997 to 2006 were retrospectively analyzed. 22 patients of them adopted continuous subcutaneous insulin infusion （CSII） pump and 18 patients of them adopted multiple subcutaneous insulin infusion （MSII）. 【Results】Two insulin use methods can both effectively control perioperative glycemic in diabetic patients during Pancreatic cancer surgery. The time to ideal preoperative blood glucose in CSII is shorter than that in MSII [CSII （5.20±1.20）d vs MSII （9.02±3.16）d,P〈0.05] and the incidence of hypoglycemia in CSII is also lower than that in MSII （CSII 13.18% vs MSII 22.22%,P〈0.05）. The fluctuating level of blood glucose during operation and in inhibititng eating phase after operation in CSII is also less than that in MSII [CSII （5.67±1.36）,MSII （7.52±4.18）,P〈0.05] and infection after operation or bad healing in incision in CSII is also less than that in MSII （CSII 4.55% vs MSII 16.67%,P〈0.05）. 【Conclusion】Two insulin use methods can both effectively control perioperative glycemic in diabetic patients during Pancreatic cancer surgery. Controling blood glucose in CSII is faster and more effective than that in MSII and the incidence of hypoglycemia and infection after operation in CSII is also less than that in MSII.