利拉鲁肽对2型糖尿病患者冠脉旁路移植术后血糖控制的疗效分析

Analysis of the effect of lialutide on blood glucose control after coronary artery bypass grafting in patients with type 2 diabetes mellitus

目的高血糖是2型糖尿病(T2DM)患者心脏术后并发症的危险因素,目前应用利拉鲁肽控制术后血糖且使用动态血糖监测系统(CGMS)评估降糖效果的研究较少。文中旨在探讨利拉鲁肽对T2DM患者冠脉旁路移植术(CABG)后血糖控制的临床疗效。方法采用前瞻性病例研究方法,选取2018年5月至2021年11月潍坊医学院附属医院心脏外科收治的44例择期行CABG的T2DM患者。按照入组顺序将患者分为利拉鲁肽组(术后利拉鲁肽联合胰岛素治疗,n=20)和对照组(术后胰岛素治疗,n=24)。所有患者均在体外循环下行CABG,术后应用持续动态血糖监测系统(CGMS),监测术后血糖7 d。对照组术后给予胰岛素降糖治疗,利拉鲁肽组术后给予利拉鲁肽联合胰岛素降糖治疗。对比两组术后7天的平均血糖值(MBG)、血糖标准差(SDBG)、葡萄糖在目标范围内时间(TIR)、血糖变异系数(CVBG)等指标。结果术后7天的利拉鲁肽组MBG、TIR、SDBG及CVBG均优于对照组(P<0.05),胰岛素用量显著低于对照组[(4.32±0.80)U/kg vs(7.38±0.68)U/kg],差异具有统计学意义(P<0.05)。结论T2DM患者行CABG术后应用利拉鲁肽联合胰岛素治疗,不仅可以有效控制术后血糖水平,降低血糖的波动幅度,而且能够减少术后胰岛素用量,并且不增加低血糖发生风险。

Objective Hyperglycemia is an independent risk factor for postoperative cardiac complications in patients with type 2 diabetes mellitus(T2DM).Insulin infusion is commonly used to control postoperative hyperglycemia,but the dose of insulin is large and the fluctuation of blood glucose is difficult to control,which is not conducive to the prognosis of patients.The purpose of this study was to investigate the clinical efficacy of liralutide on blood glucose control in patients with T2DM after coronary artery bypass grafting(CABG).Methods Using the prospective case study method,44 T2DM patients undergoing CABG from May 2018 to November 2021 in the Hospital of Weifang Medical College were randomly divided into observation group(20 cases)and control group(24 cases).All patients underwent CABG under cardiopulmonary bypass.Continuous ambulatory blood glucose monitoring system(CGMS)was used to monitor postoperative blood glucose for 7 days.The control group was given insulin hypoglycemic treatment after operation,and the observation group was given liraglutide combined with insulin hypoglycemic treatment after operation.The mean blood glucose level(MBG),the standard deviation of blood glucose(SDBG),time in range(TIR),the coefficient of variation of blood glucose(CVBG),average insulin dosage and incidence of hypoglycemia were compared between the two groups 7 days after operation.Results MBG,TIR,SDBG and CVBG in the observation group were better than those in the control group 7 days after operation(all P<0.05);The insulin dosage in the observation group[(4.32±0.80)U/kg vs(7.38±0.68)U/kg]was significantly lower than that in the control group(P<0.05);The incidence of hypoglycemia in the observation group and the control group were 5.0%(1/20)and 4.2%(1/24),with no significant difference(P>0.05).Conclusion T2DM patients were treated with liraglutide combined with insulin after CABG,which can not only effectively control the postoperative blood glucose level and reduce the fluctuation of blood glucose,but also reduce the amount of insulin after operation without increasing the risk of hypoglycemia.