动态血糖监测联合胰岛素泵在2型糖尿病合并肝细胞性肝癌患者围术期的临床应用价值研究

Clinical Value of Dynamic Glucose Monitoring Combined with Insulin Pump in the Perioperative Period of Type 2 Diabetes with Hepatocellular Carcinoma

目的评价动态血糖监测联合胰岛素泵在2型糖尿病合并干细胞性肝癌(HCC)患者围术期的临床应用价值。方法选取2013年8月—2016年8月解放军第81医院行手术治疗的合并2型糖尿病的HCC患者45例为研究对象。根据围术期治疗方法,将其分为试验组(21例,围术期使用动态血糖监测联合胰岛素泵持续皮下输注胰岛素调控血糖)和对照组(24例,围术期依据手指末梢血糖监测情况,多次多点皮下注射胰岛素)。记录患者术前3 d各个时间点(6:00、10:00、16:00、22:00)、术中各个时间点(麻醉开始时、麻醉后60 min、麻醉后2 h、麻醉清醒时)、术后3 d各个时间点(2:00、6:00、10:00、14:00、18:00、22:00)、术后4~7 d各个时间点(2:00、6:00、10:00、14:00、18:00、22:00)血糖,糖代谢参数(包括术前3 d日平均血糖、术后7 d日平均血糖、24 h胰岛素用量、全天血糖波动值、低血糖发生率),并发症发生情况。结果试验组术前3 d 6:00、10:00、16:00、22:00血糖低于对照组,术中麻醉开始时、麻醉后60 min、麻醉后2 h、麻醉清醒时血糖低于对照组,术后3 d 2:00、6:00、10:00、14:00、18:00、22:00血糖低于对照组,术后4~7 d 2:00、6:00、10:00、14:00、18:00、22:00血糖低于对照组(P<0.05)。试验组术后7 d日平均血糖、24 h胰岛素用量、全天血糖波动值、低血糖发生率低于对照组(P<0.05)。两组感染、切口裂开、胸腔积液、延迟愈合发生率比较,差异无统计学意义(P<0.05)。结论动态血糖监测联合胰岛素泵在2型糖尿病合并HCC患者围术期的临床应用价值明显优于传统监测及给药方式,能更好地保证患者围术期治疗的有效性、安全性。

Objective To evaluate the clinical value of dynamic glucose monitoring combined with insulin pump in the perioperative period of type 2 diabetes with hepatocellular carcinoma(HCC).Methods From August 2013 to August 2016,45 cases of HCC patients with type 2 diabetes treated with surgical treatment in the eighty-first Hospital of the PLA were selected.According to the perioperative treatment,the patients were divided into the experimental group(21 cases,dynamic blood glucose monitoring combined with insulin pump continuous subcutaneous infusion of insulin was used to regulate blood glucose during the perioperative period)and control group(24 cases,the insulin was injected subcutaneously on many times according to the monitoring of blood glucose at the end of the finger).Blood glucose at each time point of 3 d before operation(6:00,10:00,16:00,22:00),at each time point during the operation(at the beginning of anesthesia,60 min after anesthesia,2 h after anesthesia,and when anesthetized),at each time point of 3 d after operation(2:00,6:00,0:00,14:00,18:00,22:00),at each time point of 4-7 d after operation(2:00,6:00,0:00,14:00,18:00,22:00)were recorded.The parameters of glycometabolism including average blood glucose at 3 d before operation,average blood glucose at 7 d after operation,24 h insulin dosage,whole day blood glucose fluctuation value and incidence of hypoglycemia,the occurrence of complications were recorded.Results The blood glucose at 6:00,10:00,16:00,22:00 of 3 d before operation,at the beginning of anesthesia,60 min after anesthesia,2 h after anesthesia,and when anesthetized during the operation of experimental group was lower than that of the control group,the blood glucose at 2:00,6:00,0:00,14:00,18:00,22:00 of 3 d after operation and 4-7 d after operation of experimental group was lower than that of the control group(P<0.05).Average blood glucose at 7 d after operation,24 h insulin dosage,whole day blood glucose fluctuation value of experimental group were lower than those of the control group(P<0.05).There was no significant difference in the incidence of two groups of infection,incision dehiscence,pleural effusion and delayed union(P<0.05).Conclusion The clinical application value of continuous glucose monitoring combined with insulin pump in patients with type 2 diabetes mellitus combined with HCC is obviously better than that of traditional monitoring and medication.It can better ensure the effectiveness and safety of perioperative treatment.