围手术期高血糖应激系数研究

Preliminary study on blood glucose stress coefficient of insulin pump during perioperative period

目的探讨围手术期糖尿病患者高血糖应激系数,为糖尿病患者接受临床手术治疗时胰岛素剂量的调整提供切实可靠的依据。方法选取120例择期手术的围手术期糖尿病患者,术前3~5天给予胰岛素泵连续皮下注射治疗(CSII),至少配带至术后7天。监测病人术前、术后的生命体征,包括肝、肾功、血脂、血常规,每天测三次血糖。以胰岛素剂量为因变量,血压、脉搏、呼吸、体温等为自变量,建立回归方程;进而以每个自变量的正常值为参照,求得血糖应激系数。结果空腹血糖在8.0~9.9、10.0~13.9、14.0~17.9 mmol/L、18.0~22.0 mmol/L的应激系数分别为1.00、1.23、1.46和1.75;体温在38℃、39℃、40℃的应激系数分别为1.00、1.57、1.84;BMI在19~24.9 kg/m^2、25~27.9 kg/m^2、>28.0 kg/m^2的应激系数分别为1.00、1.12、1.18;血压(收缩压/舒张压)在90~140/60~80 mm Hg、140~180/90~110 mm Hg、180~200/110~130 mm Hg的应激系数分别为1.00、1.30、1.45;糖尿病病史在0~5、5~10、10~15年的应激系数分别为1.00、1.11、1.23。结论根据不同应激情况选择相应的应激系数可快速计算出手术患者的胰岛素剂量,达到快速平稳控制血糖的目的。

Objective To investigate the blood glucose stress coefficient of insulin pump in diabetic patients during perioperative period,and to provide reliable evidence for the adjustment of insulin dosage in the treatment of diabetes mellitus. Methods 120 patients with diabetes mellitus during perioperative period were selected,were given insulin pump continuous subcutaneous injection treatment（ CSII） before operation for 3 ～ 5days,equipped at least 7 days after surgery,preoperative and postoperative vital signs of patients were monitored,including the liver,renal function,blood lipid,blood routine,and blood glucose was measured three times every day,Taking insulin dose as the dependent variable,blood pressure,pulse,respiration,body temperature and so on were the independent variables,and the regression equation was established; By using the normal values of each independent variable as the reference,the coefficient of blood glucose stress was obtained. Results The stress coefficients of 14.0 ～ 17.9,10.0 ～ 13.9,18.0 ～ 22.0 and mmol / L 8.0 ～ 9.9 were 1,1. 23,1. 46 and 1. 75,respectively; The stress coefficient of temperature in 38,39,40 degrees of C were 1,1. 57,1. 84; The stress coefficients of BMI in 19 ～ 24. 9,25 ～ 27. 9 and〉 28 kg / m^2 were 1,1. 12 and 1. 18,respectively; The stress coefficient of blood pressure（ systolic / diastolic） in 90 ～ 140 / 60 ～ 80,140 ～ 180 / 90 ～ 110 and mm Hg 180 ～ 200 /110 ～ 130 were 1,1.30 and 1.45,respectively; The stress coefficient of diabetes in 0 ～ 5,5 ～ 10 and 10 ～ 15 were1,1.11 and 1. 23,respectively. Conclusions According to different stress conditions,the corresponding stress coefficient can be calculated quickly,to achieve the goal of rapid and smooth control of blood glucose.