原位肝移植术后严格的血糖控制对术后早期感染的影响(1)
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[摘要] 目的：探讨对施行原位肝移植患者在术后2周内采用严格的血糖控制方案对于预防术后早期感染的意义。方法：选取121例原位肝移植患者，所选患者术前状态、术前肝功能Child-Pugh评分、供肝质量、围术期处理及免疫抑制剂应用方面无显著性差异(P>0.05)，将患者随机分为A、B、C三组，通过严密的血糖监测，将三组患者血糖分别控制在A组<7.0 mmol/L、7.0 mmol/L≤B组<11.0 mmol/L、11.0 mmol/L≤C组<13.0 mmol/L，比较各组患者术后2周内感染的发生情况。结果：三组患者在术后4 d和术后7 d时感染情况无显著性差异(P>0.05)，术后2周时C组患者感染例数明显增加(P<0.05)，各组间感染病原体和感染部位无显著性差异(P>0.05)。结论：原位肝移植术后2周内进行严格的血糖控制可以减少术后早期感染的发生率。本研究显示，将血糖控制在11.0 mmol/L以下对于肝移植术后早期患者较为安全。
[关键词] 原位肝移植；感染；血糖
[中图分类号] R617[文献标识码]A [文章编号]1673-7210(2009)05(b)-007-03
Effect of strict blood glucose control after orthotopic liver transplantation on early postoperative infection
FAN Pengfei1,2
(1.Graduate School of Tianjin Medical University, Tianjin 300070, China; 2.Transplant Division, the First Central Hospital of Tianjin City, Tianjin 300192, China)
[Abstract] Objective: To explore the significance of strict blood glucose control within 2 weeks after orthotopic liver transplantation for preventing early postoperative infection. Methods: 121 patients underwent orthotopic liver transplantation, who had no significantly statistical difference in preoperative status, preoperative liver function Child-Pugh score, graft quality, perioperative management and the application of immunosuppressive drugs (P>0.05), were selected and randomly divided into three groups: group A, B and C. The blood glucose control of three groups: group A<7.0 mmol/L, 7.0 mmol/L≤group B<11.0 mmol/L, 11.0 mmol/L≤group C<13.0 mmol/L, then the infection within 2 weeks of the three groups were compared. Results: There was no significant difference in infection among three groups after 4 and 7 days (P>0.05), but after 2 weeks group C was increased in the number of infected cases (P<0.05), and no significant difference in pathogens and site of infection (P>0.05). Conclusion: After orthotopic liver transplantation within 2 weeks, strict blood glucose control could reduce the incidence of early postoperative infection rate. This study showed that blood glucose<11.0 mmol/L after liver transplantation for patients is generally considered safe ......
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