口腔颌面部肿瘤合并糖尿病患者术后血糖管理方案的优化

Post-operative glucose control through liquid diet and glucocorticoid use for diabetic patients with oral tumors

目的探讨口腔颌面部肿瘤合并糖尿病患者行外科手术后,在应用地塞米松和经鼻胃管流质饮食期间的血糖控制方案。方法 33例患者术后采用少量多次流质饮食,甘精胰岛素联合中效胰岛素方案控制血糖,与去年同期28例患者采用3餐方式流质饮食,使用预混胰岛素控糖方案比较,观察在地塞米松应用期间血糖达到较好控制的人数、达到较好控制所需时间、血糖>20 mmol/L的次数、临时追加短效胰岛素次数和发生低血糖的次数。结果采用少量多次流质饮食、甘精胰岛素联合中效胰岛素控糖方案较3餐流质饮食、预混胰岛素方案有更多患者血糖达到较好控制,且达标所需时间减少,血糖>20mmol/L和需要临时追加短效胰岛素次数减少,而低血糖发生次数无增加。结论采用少量多次鼻饲流质饮食,甘精胰岛素联合中效胰岛素方案较既往方案可以使血糖在更短时间内得到较好控制,严重高血糖次数发生减少,是一种较好的口腔颌面部手术后血糖管理方案。

Objective The purpose of this study was to compare the new method of glucose control for diabetic patients with liquid diet and dexamethasone infusion after oral and maxillofacial surgery.Methods We conducted a retrospective observation of 33 post-operative patients with small amount of liquid food but more frequent ingestion through nasogastric tube,who were given daily insulin glargine and NPH in our hospital between October 2009 and December 2010 in comparasion to 28 patients with enteral liquid food 3 times a day and use of premixed insulin between October 2008 and september 2009,to investigate the time when glucose achieved reasonable control during application of dexamethasone and number of patients who achieved reasonable control.We also studied the frequency of severe hyperglycemia（blood glucose greater than 20 mmol/L） and hypoglycemia.Results Compared with the patients with 3 main meals and premixed insulin,the diabetic patients fed repeated small amount of liquid food and glargine insulin to control blood sugar achieved reasonable blood sugar control（P0.05） in greater number,while in less time（P0.05）,and had decreased frequency of severe hyperglycemia and provisional application of short acting insulin（P0.05）.Conclusions Frequent small amount of enteral liquid food together with glargine and NPH insulin is a better method for glucose control during the use of dexamethasone in diabetic patients after oral and maxillofacial surgery.