血糖水平与胰腺癌合并糖尿病患者术后恢复的相关性

Correlation between blood glucose level and the prognosis of postoperative pancreatic cancer patients with diabetes

目的 探讨血糖水平与胰腺癌合并糖尿病患者术后恢复的关系.方法 根据血糖控制水平,将68例胰腺癌合并糖尿病术后患者分为强化组（血糖控制在4.4～6.1 mmol/L）和对照组（血糖控制在6.1～11.1 mmol/L）,各34例.检测术后1、3、7d的空腹血糖（FBG）、空腹胰岛素定量（FINS）及C反应蛋白（CRP）水平,分析两组患者术后恢复情况及并发症发生情况.结果 强化组术后3d的FBG、FINS、CRP水平分别为（6.94±0.94） mmol/L、（17.38 ± 7.37） mmol/L、（108.33±37.25） mg/L,对照组分别为（7.81±1.36） mmol/L、（23.73±8.25） mmol/L、（131.51±42.34） mg/L,强化组较对照组显著降低,差异均有统计学意义（P值均＜0.05）.强化组患者术后发热时间、排气时间、抗生素使用时间分别为（1.4±0.8）、（3.1±0.7）、（2.5 ±0.5）d,显著少于对照组的（2.5±1.1）、（4.6±0.8）、（3.7 ±0.8）d,差异均有统计学意义（P值均＜0.05）.强化组切口感染率显著低于对照组（5.9％比23.5％,P＜0.05）,其他术后并发症发生率及病死率与对照组比较差异无统计学意义.结论 强化血糖控制可改善胰腺癌合并糖尿病患者术后胰岛素抵抗,减轻术后的炎性反应,促进患者恢复,且不增加术后并发症的发生率.

Objective To explore the correlation between blood glucose and postoperative recovery of pancreatic cancer patients with diabetes.Methods According to the level of glycemic control after operation,68 cases of pancreatic cancer patients with diabetes were divided into two groups,including 34 cases of intensive control group （blood glucose 4.4 ～ 6.1 mol/L）,34 cases of control group （blood glucose 6.1 ～11.1 mol/L）.Fasting blood glucose （FBG）,fasting insulin （FINS） and C reaction protein （CRP） in all patients were detected at 1st,3rd and 7th day after operation,and the recovery condition,postoperative complications and other clinical data were compared and analyzed.Results FBG,FINS and CRP in intensive control group were （6.94 ± 0.94） mmol/L,（17.38 ± 7.37） mmol/L,（108.33 ± 37.25） mg/L,and in control group were （7.81 ± 1.36） mmol/L,（23.73 ± 8.25） mmol/L,（131.51 ± 42.34） mg/L at 3rd day after operation.There were significant difference in serum FBG,FINS and CRP level between the two groups at 3rd day after operation （P ＜ 0.05）.Compared with control group,postoperative duration of fever [（1.4 ± 0.8） vs （2.5 ± 1.1） d],duration of antibiotics [（3.1 ± 0.7） vs （4.6 ± 0.8） d] and time of anal exhaust [（2.5 ±0.5） vs 93.7 ± 0.8）d] in intensive group were significantly reduced （P ＜ 0.05）.The wound infection rate in intensive control group was significantly decreased （5.9％ vs 23.5％,P ＜0.05）,the rate of mortality and other postoperative complications between the two groups was not statistically significant （P＞0.05）.Conclusions Intensive glycemic control can contribute to improve insulin resistance,reduce inflammation reaction and improve the prognosis of postoperative pancreatic cancer patients with diabetes,and it does not increase the postoperative complication rate.