皮下动态葡萄糖监测系统在肿瘤患者术后应激性高血糖强化胰岛素治疗中的应用

Application of subcutaneous dynamic glucose monitoring system in intensive insulin therapy of postoperative stress hyperglycemia in patients with cancer

目的探讨皮下动态葡萄糖监测系统（DGMS）对肿瘤患者术后发生应激性高血糖进行实时动态血糖监测的效果。方法将恶性肿瘤术后出现血糖水平持续升高的136例患者，按照随机数字表法分为观察组（DGMS组）和对照组（快速微量血糖监测组），每组68例，指导实施强化胰岛素治疗，观察两组患者每天平均血糖值、7d胰岛素使用剂量，并进一步比较两组低血糖事件发生率、切口感染和肺部感染发生率、白介素-6（IL-6）与C-反应蛋白（CRP）水平及ICU入住时间。结果第1—7天每天平均血糖值观察组患者分别为（10．9±7．5），（7．1±3．4），（6．7±3．9），（6．9±3．6），（6．8±3．5），（6．7±3．5），（6．7±3．6）mmol／L，优于对照组患者的（11．1±7．7），（7．6±5．4），（7．3±5．6），（7．9±4．9），（7．4±4．4），（7．7±4．1），（7．7±4．2）mmol／L，差异有统计学意义（t分别为1．989，2．221，2．156，2．143，2．857，2．263，2．274；p〈0．05）；观察组7d血糖均值为（7．1±3．2）mmol／L，优于对照组的（7．9±5．3）mmol／L，差异有统计学意义（t=2．951，P〈0．05）；观察组患者7d使用胰岛素总量为（163．9±34．2）U，低于对照组的（192．2±45．6）U，差异有统计学意义（t=2．712，P〈0．05）；观察组低血糖、切口感染、肺部感染发生率分别为2．94％，1．47％，8．82％，低于对照组的11．76％，5．88％，22．05％，差异均有统计学意义（）（。分别为3．886，4．781，4．561；P〈0．05）；观察组患者IL-6水平为（34．6±7．8）ng／L，CRP水平为（121．3±23．2）ms／L，ICU入住时间为（14．6±10．3）d，均优于对照组的（41．1±6．3）ng／L，（162．2±32．1）mg／L，（16．1±13．4）d，差异均有统计学意义（t分别为2．955，3．126，2．115；P〈0．05）。结论采用DGMS的方法能有效维持目标血糖，减少血糖控制治疗过程中并发症的发生，与床旁快速微量血糖监测的方法相比较，对指导肿瘤患者术后应激性高血糖实施胰岛素强化治疗更有效、更安全。

Objective To explore the real-time dynamic blood glucose monitoring effect of subcutaneous dynamic glucose monitoring system （DGMS） in intensive insulin therapy of postoperative stress hyperglycemia in patients with cancer. Methods One hundred and thirty-six cancer patients with continuous postoperative hyperglycemia were randomly divided into the observation group （ DGMS group） and the control group （fast and trace blood glucose monitoring group）, each with 68 cases. All patients received the intensive insulin therapy. The daily average blood glucose, insulin dosage in the sever days, the incidence of hypoglycemia, the incidence of wound infection and pulmonary infection, the levers of IL-6 and CRP and the days in ICU were compared between two groups. Results The average blood glucose from first day to seventh day in the observation group were respectively （ 10.9 ± 7.5 ）, （7.1± 3.4）, （6.7 ± 3.9 ）, （ 6.9 ± 3.6 ）, （6.8±3.5）, （6.7±3.5）, （6.7±3.6） mmol/L, and were better than （11. 1 ±7.7）, （7.6 ±5.4）, （7.3 ±5.6）, （7.9 ±4.9）, （7.4±4.4）, （7.7±4.1）, （7.7±4.2） mmolfL in the control group, and the differences were statistically significant （t = 1. 989, 2. 221, 2. 156, 2. 143, 2. 857, 2. 263, 2. 274,respectively; P 〈 0.05 ）. The average blood glucose in the seven days in the observation group was （7.1 ± 3.2） mmol/L, and was better than （7.9 ±5.3） mmol/L in the control group, and the difference was statistically significant （t = 2. 951, P 〈 0.05）. The insulin dosage in the seven days in the observation group was （163.9 ＋ 34.2） U, and was lower than （ 192.2 ± 45.6 ） U in the control group, and the difference was statistically significant （t =2.712, P 〈 0.05）. The incidence of hypoglycemia, wound infection and pulmonary infection were respectively 2.94%, 1.47%, 8.82% in the observation group, and were lower than 11.76%, 5.88%, 22.05% in the control group, and the differences were statistically significant （ x2 = 3. 886, 4. 781, 4. 561, respectively; P 〈 0.05 ）. The level of IL-6 was （34.6 ± 7.8） ng/L, the level of CRP was （ 121.3 ± 23.2） mg/L, the days in ICU were （ 14.6 ± 10.3 ） d in the observation group, and were better than （41.1 ± 6.3 ） ng/L, （162.2± 32.1 ）mg/L, （16.1 ± 13.4） d in the control group, and the differences were statistically significant （t = 2. 955, 3. 126, 2. 115, respectively; P 〈 0.05 ）. Conclusions The DGMS method can effectively maintain the target blood glucose, and reduce the incidence rate of the complications in the control of blood glucose. Compared with the bedside fast and trace blood glucose monitoring, the DGMS method is safer and more effective to implement the intensive insulin therapy of postoperative stress hyperglycemia in patients with cancer.