全胰切除术后患者血糖曲线监测及血糖控制的临床意义

Clinical significance of blood glucose curve monitoring and blood glucose control after total pancreatectomy

目的探讨术后血糖曲线监测及血糖控制对全胰切除术后患者血糖及预后的影响。方法80例行全胰切除术的胰腺癌患者分为研究组(n=42)和对照组(n=38)。2组患者术后均给予肠内营养及肠外营养。对照组进行常规血糖监测及胰岛素使用,研究组提升术后48 h内监测频次,绘制血糖曲线,并依据曲线变化特征调整胰岛素剂量及使用方式。比较2组患者术后空腹血糖水平、血糖稳定性、术后并发症及康复情况。结果研究组术后48 h^7 d空腹血糖水平低于对照组(P<0.05)。研究组术后72 h及7 d血糖不稳定指数低于对照组(P<0.05)。研究组术后感染、伤口愈合延迟、低血糖发生率低于对照组,但差异无统计学意义(P>0.05)。研究组住院时间显著短于对照组(P<0.05)。结论血糖曲线监测及血糖控制可提升全胰腺切除术后血糖控制效果,减少血糖波动,降低并发症发生风险,对改善近期预后具有重要意义。

Objective To evaluate the effect of postoperative blood glucose monitoring and blood glucose control on blood glucose and prognosis of patients after total pancreatectomy.Methods Eighty patients undergoing total pancreatectomy for pancreatic cancer were enrolled and divided into study group(n=42)and control group(n=38).Both groups of patients were given enteral nutrition and parenteral nutrition after operation.The control group performed routine blood glucose monitoring and insulin use.The control group accepted a higher frequency of monitoring within 48 hours after surgery,and the insulin dosage and method were adjusted according to the blood glucose curve.Postoperative fasting blood glucose levels,blood glucose stability,postoperative complications and rehabilitation were compared between the two groups.Results The fasting blood glucose level of the study group from 48 h to 7d after operation was significantly lower than that of control group(P<0.05).The glycemic lability index of the study group after 72h and 7d was significantly lower than that of the control group(P<0.05).The incidence of postoperative infection,delayed wound healing and hypoglycemia in the study group was lower than that in the control group respectively,but no significant difference was showed between two groups(P>0.05).The hospital stay of study group was significantly shorter than that of control group(P<0.05).Conclusion Monitoring of blood glucose curve and blood glucose control can significantly improve the effect of blood glucose control after total pancreatectomy,reduce blood glucose fluctuations,and reduce the occurrence of complications,which is of great significance to short-term prognosis of patients.