肝硬化患者内镜下食管静脉曲张套扎术后低血糖原因分析

Analysis of the causes of hypoglycemia after the endoscopic variceal ligation in patients with liver cirrhosis

目的探讨肝硬化患者内镜下食管静脉曲张套扎(EVL)术后发生低血糖的原因,为EVL术后制定合理治疗护理方案提供参考依据,减少EVL术后低血糖的发生。方法回顾性分析2014年1月至2016年1月在四川大学华西医院消化内科行EVL术的肝硬化患者共计385例的临床资料。结果肝硬化患者EVL术后发生低血糖共73例(18.96%),低血糖的发生时间多集中在术后24 h内(56.16%);空腹高血糖患者术后更易发生低血糖(χ~2=8.894,P=0.003);肝硬化合并糖尿病患者较肝硬化未合并糖尿病患者术后更易发生低血糖,差异具有统计学意义(χ~2=69.63,P=0.000);不同肝功能Child-Pugh分级患者术后是否发生低血糖之间差异无统计学意义(χ~2=1.313,P=0.519)。结论肝硬化患者EVL术后低血糖发生率高,术前应对患者进行糖耐量筛查、规范血糖和糖化血红蛋白的监测,制定并执行个性化能量补充方案,以减少患者术后低血糖的发生、缩短住院时间、提高EVL术治疗质量。

Objective To analyze the causes of hypoglycemia after endoscopic variceal ligation（EVL） in patients with liver cirrhosis and provide reference for caring patients after EVL in order to reduce the incidence of hypoglycemia in EVL. Methods Clinical data 385 patients with liver cirrhosis who had EVL in our department from January 2014 to January 2016 were retrospectively analyzed. Results Seventythree patients（18. 96%） had hypoglycemia after EVL. The occurrence of hypoglycemia was mostly in 24 h after EVL（56. 16%）. Patients with fasting hyperglycemia were more likely to have hypoglycemia after EVL（χ^2= 8. 894,P = 0. 003）. liver cirrhosis patients combined with diabetes were more prone to have hypoglycemia than liver cirrhosis patients without diabetes,and the difference was statistically significant（χ^2= 69. 63,P = 0. 000）. There was no statistically significant difference in patients with different liver function Child-Pugh levels whether having hypoglycemia after EVL or not（ χ^2= 1. 313,P = 0. 519）.Conclusions The incidence of hypoglycemia was high in liver cirrhosis patients after EVL,and it is necessary to screen for sugar tolerance,to monitor blood sugar and glycosylated hemoglobin. The individualized energy supplementation scheme should be developed and implemented to reduce the occurrence of hypoglycemia in EVL,shorten hospital stay and improve the quality of EVL treatment.