快速康复对胰十二指肠切除术后患者应激性高血糖的影响

Stress hyperglycemia after pancreatieoduodeneetomy in patients following enhanced recovery programmes

目的 探讨快速康复对胰十二指肠切除术后患者应激性高血糖的影响.方法 以实施快速康复程序前胰十二指肠切除术的40例患者为对照组,实施快速康复程序后胰十二指肠切除术的52例患者为试验组,比较2组术后1、3、7 d空腹血浆葡萄糖及各组术后3 d末梢血糖波动的差异.结果 试验组术后1、3、7 d空腹血浆葡萄糖分别为（8.27±1.99）、（6.78±1.22）、（7.29±1.21）mmol/L,对照组术后1、3、7 d空腹血浆葡萄糖分别为（10.46±5.17）、（7.88±2.98）、（7.29±2.94）mmol/L,差异均有统计学意义（t=2.545、2.219、2.683,均P〈0.05）;试验组术后1、2、3 d的末梢血糖波动值分别为（3.47±1.98）、（3.16±1.46）、（2.74±1.49）mmol/L,对照组术后1、2、3 d的末梢血糖波动值分别为（4.13±2.36）、（3.26±1.59）、（4.07±2.74）mmol/L,其中术后1、2 d的末梢血糖波动值差异无统计学意义（t=1.479、0.308,均P〉0.05）,术后3 d的末梢血糖波动值差异有统计学意义（t=2.739,P〈0.05）.结论 快速康复有利于减轻胰十二指肠切除术患者应激性高血糖及术后血糖波动,促进术后快速康复.

Objective To investigate the effect of enhanced recovery after surgery （ERAS） on stress hyperglycemia in patients after pancreaticoduodenectomy （PD）. Methods Patients matched inclusion and exclusion standards were divided into two groups. The patients after PD before the implementation of ERAS programme were named as the control group （40 cases）. The patients after PD with the implementation of ERAS programme were named as the experimental group （52 cases）. The fast blood glucose （FBG） in postoperative day （POD） 1, 3, 7 and the volatility of capillary blood glucose during postoperative 3 days were compared between the two groups. Results The FBG in POD1, POD3, POD7 were （8.27 ± 1.99）, （6.78 ± 1.22）, （5.97 ± 1.21） mmol/L in the experimental group respectively, and the FBG in POD1, POD3, POD7 were （10.46 ± 5.17）, （7.88 ± 2.98）, （7.29 ± 2.94） mmol/L in the control group respectively, there were significant differences between two groups （t=2.545, 2.219, 2.683, all P〈0.05）. The volatility of capillary blood glucose during postoperative 3 days in the experimental group were （3.47± 1.98）, （3.16 ± 1.46）, （2.74 ± 1.49） mmol/L respectively, and the volatility of capillary blood glucose during postoperative 3 days in the control group were （4.13±2.36）, （3.26±1.59）, （4.07±2.74） mmol/L respectively, no significant differences were found in the volatility of capillary blood glucose in POD1 and POD2 between the two groups （t=1.479, 0.308, all P 〉 0.05）, while significant differences were found in the volatility of capillary blood glucose in POD3 between the two groups （t=2.739, P〈0.05）. Conclusions It can be concluded that ERAS may be useful to decrease stress hyperglycemia and the volatility of capillary blood glucosein patients after PD, and accelerate the recovery of patients after PD.