全胰切除术后患者营养治疗及血糖管理研究

Nutritional Therapy and Blood Glucose Management in Patients After Total Pancreatectomy

目的总结全胰切除术后患者营养治疗及有效控制血糖的方法。方法总结2016年1月—2018年1月南京医科大学第二附属医院胰腺中心12例行全胰切除术患者的临床资料,尤其是术后营养治疗和血糖管理方面的经验。结果 12例患者均顺利完成手术,无围术期死亡。肠外营养期间患者血糖平均为9.3 mmol/L(7.5～15.3 mmol/L)、静脉泵入胰岛素的量平均为28.3 U/d(20.0～30.0 U/d)、静脉泵入胰岛素的速度平均为1.2U/h(0.5～3.0U/h);肠内营养期间患者血糖平均为8.7mmol/L(5.3～12.7mmol/L)、静脉泵入胰岛素的量平均为24.7 U/d(18.0～28.0 U/d)、静脉泵入胰岛素的速度平均为1.0 U/h(0.3～2.0 U/h);经口进食期间血糖平均为7.5 mmol/L(2.3～10.5 mmol/L),1例患者发生1次低血糖(2.3 mmol/L)、皮下注射短效胰岛素的量平均为13.7 U/d(10.0～18.0 U/d)、皮下注射长效胰岛素的量平均为8.0 U/d(6.0～10.0 U/d)、补充胰酶制剂的量平均为705 U/d(600～900 U/d)。结论全胰切除术后血糖管理是护理工作的重中之重,根据患者术后不同的营养支持方式,从胰岛素精准输注、血糖密切监测、低血糖有效防治、胰酶替代治疗这些方面对术后血糖进行有效管理。

Objective To summarize the nutritional treatment and effective control of blood glucose in patients after total pancreatectomy. Methods To summarize the clinical data of 12 patients undergoing pancreatectomy in the pancreatic center of the Second Affiliated Hospital of Nanjing Medical University from January 2016 to January 2018, especially the experience of postoperative nutritional therapy and blood glucose management. Results All 12 patients successfully completed the operation without death during perioperative period. During parenteral nutrition, the average blood glucose level was 9.3 mmol/L(7.5 ~ 15.3 mmol/L), the average amount of intravenously pumped insulin was 28.3 U/d(20.0 ~ 30.0 U/d), and the rate of intravenous insulin injection was on average. 1.2 U/h(0.5 ~ 3.0 U/h); the average blood glucose of patients during enteral nutrition was 8.7 mmol/L(5.3 ~ 12.7 mmol/L), and the amount of intravenously pumped insulin was 24.7 U/d(18.0 ~ 28.0 U/d), the rate of intravenous insulin injection was 1.0 U/h(0.3 ~ 2.0 U/h); the average blood glucose during oral feeding was 7.5 mmol/L(2.3 ~ 10.5 mmol/L), and 1 patient occurred. The average amount of hypoglycemia(2.3 mmol/L), subcutaneous injection of short-acting insulin was 13.7 U/d(10.0 ~ 18.0 U/d), and the amount of subcutaneous injection of long-acting insulin was 8.0 U/d(6.0 ~ 10.0 U/d), the amount of supplemented trypsin was 705 U/d(600 ~ 900 U/d) on average. Conclusion Blood glucose management after total pancreatectomy is the most important aspect of nursing work. According to different nutritional support methods after surgery, accurate insulin infusion, close monitoring of blood glucose, effective prevention and treatment of hypoglycemia, and pancreatic enzyme replacement therapy Blood sugar is managed effectively.