不同血糖控制方法对糖尿病患者围手术期疗效的比较

Comparison of the Efficacy of Different Glycaemic Control Methods for the Treatment of Patients with Diabetes Mellitus During Peroperative Period

【目的】比较采用胰岛素泵和诺和灵R笔芯与来得时笔芯（甘精胰岛素注射液）皮下注射CSⅡ、甘精胰岛素皮下注射联合口服降糖药两种方法对胆石症合并T2DM腹腔镜择期手术患者围手术期血糖控制和愈后的影响。【方法】胰岛素泵（A组）110例，胰岛素泵持续24h皮下输入胰岛素的方式控制血糖；甘精胰岛素皮下注射（B组）123例，使用来得时笔芯及口服降糖药。【结果】A组患者在控制血糖达理想值所需平均时间、平均住院时间方面明显少于B组，组间差异显著（P〈O．05），但降糖费用明显高于B组（P〈0．05），平均总住院费用两组间无显著差异（P〉0．05），两组患者低血糖发生率、抗生素使用时间等并发症相关因素指标以及血糖平稳程度，无显著差异（P〉0．05）。两组均无切口感染及酮症发生。【结论】两种方法控制围手术期病人血糖水平各有其长。甘精胰岛素联合口服药对围手术期患者的血糖控制安全、便捷，为T2DM患者围手术期血糖控制的理想方法之一。

[Objective] To compare the effect of two methods insulin pump CS Ⅱ vs glargine insulin injection combined with oral blood glucose lowering drugs on glycaemie control and prognosis of patients with cholelithiasis and type 2 diabetes mellitus（T2DM） during peroperative period of laparoscopy elective surgery. [Methods]Insulin pump CSⅡ group（ n = 110） received 24h continuous subcutaneous insulin injection through insulin pump for con- trolling blood glucose. Glargine insulin subcutaneous injection group（ n = 123） received Lantus cartridge and oral blood glucose lowering drugs. [Results] Mean time to reaching the ideal glueose value and average hospital day in patients of CS Ⅱ group were obviously lower than those in glargine insulin group, and there was significant differ- ence between two groups（ P 〈0.05）. But the eost of lowering glucose in CSII group was obviously higher than that in glargine insulin group（ P 〈0.05）. There was no significant difference in the average total hospitalization cost between two groups（ P ）0.05）. There was no significant difference in the complication-related faetors sueh as the incidence of hypoglycemia, infection and ketosis, mean stiteh removal time and the use time of antibiotics and the stability of blood glucose between two groups（ P ：〉0.05）. [Conclusion] Glargine insulin combined with o- ral blood glucose lowering drugs for glyeaemic control of peroperative patients is safe, effective, flexible and easy, so it is one of the ideal methods for glycaemic control of T2DM patients during preoperative period.