规范化静脉胰岛素泵管理改善肝移植术后早期血糖增高的探究

Study on the management of standardized intravenous insulin pump for early blood glucose increase after liver transplantation

目的评估静脉胰岛素泵对肝移植术后早期血糖增高的疗效,为移植术后早期血糖增高规范化管理提供依据。方法回顾性分析我院2018年10月-2019年8月80例行肝移植患者术后使用静脉胰岛素泵管理早期血糖增高的效果以及对患者术后相关指标影响情况。根据是否实施规范化静脉胰岛素泵管理,将患者分为2组:对照组(n=40)2018年10月-2019年3月未实施规范化静脉胰岛素泵管理组;观察组(n=40)2019年3月-2019年8月实施规范化静脉胰岛素泵管理组,即根据患者病史以及血糖情况由医生和护士共同制定静脉胰岛素泵的治疗方案,由护士根据患者血糖水平进行动态量化监测调节。统计患者饮食前后2 h以及睡前血糖值、术后血糖处于正常值的时间、胰岛素日摄入量、相同时间段伤口愈合程度及痊愈时间、患者再次感染的病例数、发生低血糖的病例数等指标。结果住院期间,观察组患者术后高血糖控制效果以及术后相关指标显著优于对照组,差异具有统计学意义(P <0.05)。结论规范化后的静脉胰岛素泵治疗可以较好地控制患者高血糖,同时能减少血糖波动,有效降低低血糖发生率,优于常规静脉胰岛素泵治疗,值得临床推广。

Objective To evaluate the effect of intravenous insulin pump on early hyperglycemia after liver transplantation, so as to provide a basis for the standardized management of early hyperglycemia after liver transplanta tion. Methods Retrospective analysis was performed on the effect of intravenous insulin pump on the management of early hyperglycemia after liver transplantation in patients who underwent liver transplantation from October 2018 to August 2019 and the impact on the related postoperative indicators. According to whether standardized intravenous insulin pump management was implemented, the patients were divided into two groups: the control group( n =40), and the group without standardized intravenous insulin pump management from October 2018 to March 2019. Observation group( n = 40). The standardized intravenous insulin pump management group was implemented from March to August, 2019. That is, according to the patient’s medical history and blood glucose situation, the treatment plan of the intravenous insulin pump was jointly developed by doctors and nurses, and the nurse conducted dynamic quantitative monitoring and adjustment according to the patient’s blood glucose level. The blood glucose level 2 hours before and after diet and before and after sleep, the time when blood glucose was normal after surgery, daily insulin intake, wound healing degree and recovery time in the same period, the number of patients with re-infection, the number of cases of hypoglycemia and other indicators were counted. Results Postoperative hyperglycemia control effect in hospitalized liver transplantation patients was significantly better in the observation group than in the control group, with statistically significant difference(P > 0.5). Conclusion The standardized intravenous insulin pump treatment can better control patients’ hyperglycemia, reduce blood glucose fluctuations and effectively reduce the incidence of hypoglycemia, etc.. This strategy is better than the conventional intravenous insulin pump treatment and it is worth of clinical application.