地特胰岛素用于2型糖尿病患者胃肠道手术围手术期的疗效观察

Effect of insulin detemir on gastrointestinal surgery glycemic control in type 2 diabetc patients

目的探讨地特胰岛素对2型糖尿病患者胃肠道手术围手术期血糖控制的影响。方法选择34例接受胃肠道手术的2型糖尿病患者,分为地特胰岛素治疗组(观察组)、胰岛素常规强化治疗组(对照组)各17例。研究组术前1周采用地特胰岛素(早7点)加三餐前短效胰岛素皮下注射进行血糖控制,手术当日仍采用原量进行地特胰岛素注射,停短效胰岛素,术后继续使用地特胰岛素原剂量,并视空腹血糖变化情况调整剂量,若进食可进行餐前胰岛素注射。对照组采用传统胰岛素强化治疗方案进行术前准备,手术当日停用胰岛素,术后改静脉胰岛素输注,患者进食后改回原胰岛素治疗方案。结果观察组患者在手术日及术后第1天、第2天、第3天的空腹血糖分别为(5.5±0.9)、(6.9±0.8)、(6.7±0.8)、(6.5±0.8)mmol/L,对照组空腹血糖分别为(6.2±0.8)、(7.6±0.7)、(7.5±0.8)、(6.7±1.2)mmol/L。观察组的空腹血糖在手术日、术后第1天、第2天显著低于对照组组(P=0.03,P=0.02和P=0.01)。两组均无低血糖发生,伤口愈合良好。结论地特胰岛素对2型糖尿病患者胃肠道手术围手术期血糖控制良好,低血糖发生少,具有安全、有效和易接受等特点。

Objective Toinvestigate the effect of insulin detemir on gastrointetinal surgery perioperative glycemic control in type2 diabetic patients. Methods Retrospectively analyzed the clinical data of 17 type 2 diabetic inpatients treated with insulin detemir（ research group） and 17 type 2 diabetic inpatients treated with tradional intensified insulin therapy（ control group） for gastrointestinal surgery perioperative glycemic control. Results The fasting glucose values of the diabetic patients in the reaearch groupon the day of surgery and the frist 3 days postoperative days were（ 6. 5 ± 1. 2） 、（ 7. 5 ± 1. 4） 、（ 7. 2 ± 1. 2） 、（ 7. 0 ± 1. 1） mmol/L,respectively,and were（ 8. 1 ± 1. 4） 、（ 9. 2 ± 1. 5） 、（ 8. 6 ± 2. 1） 、（ 8. 8 ± 2. 7） mmol/L in the control group,respectively. The fasting blood glucose values in the research were significantly. Lower than the control group on the operative day,the first,second postoperative day（ P =0. 03,0. 02 and 0. 01 respectively）. No hypoglycemic events were observed and all wounds were healed well in both groups. Conclusion With satisfied fasting blood glucose level and fewer episode of hypoglycemia,gastrointestinal surery perioperative glycemic control by insulin detemir in type 2 diabetic patients is safe,effective and acceptive.