糖尿病肝切除患者胰岛素不同给药途径的疗效观察(1)
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[摘要] 目的：探讨糖尿病患者肝切除术后不同胰岛素给药途径控制血糖的有效性、安全性和实用性。方法：将我院63例因肝脏肿瘤行肝切除的糖尿病患者随机分为胰岛素静脉泵入组(n=31例)和胰岛素静脉滴注组(n=32例)，比较两组术后输液量及血糖的控制水平。结果：两组术后禁食期间输液量差异无统计学意义(P>0.05)。术后第1天和第2天，静脉泵入组与静脉滴注组血糖水平差异无统计学意义(P>0.05)；术后第3天，静脉滴注组的血糖值[(4.52±0.80)mmol/L]显著优于静脉泵入组[(8.00±1.15)mmol/L]，差异有统计学意义(P<0.05)。结论：糖尿病患者肝切除术后，胰岛素直接加入全胃肠外营养液静脉滴注血糖控制达到理想标准时间短，是一种值得推广的给药途径。
[关键词] 糖尿病；胰岛素；肝切除
[中图分类号] R587.1 [文献标识码] B [文章编号] 1673-7210(2012)01(a)-137-02
Clinical observation of different administration ways of Insulin in diabetics patients after hepatic resection
ZHAO Jie, JIANG Cuicui, DONG Guoqing, CAO Yu'neng, LI Ji, YANG Li
General Hospital of PLA, Beijing 100853, China
[Abstract] Objective: To explore the efficacy of different Insulin injection ways in patients with diabetics after hepatic resection. Methods: A total of 63 patients with diabetics who were adopted hepatic resection surgery in our hospital were divided into Insulin pumps group (n=31) and Insulin intravenous drip group (Insulin direct into the TPN, n=32). Postoperative infusion volume and blood glucose concentration were surveyed and compared. Results: The infusion volume during fasting period was compared between the two groups, the difference was not statistically significant (P>0.05). On the first and second day of post-operation, the blood glucose concentration had no significant difference between the two groups. However, the value of blood glucose concentration in Insulin intravenous drip group [(4.52±0.80) mmol/L] was better than that in Insulin pumps group [(8.00±1.15) mmol/L] on 3th day of post-operation. Conclusion: Carrying insulin direct into the TPN can steady control the blood glucose concentration and it is an effective way of Insulin administration in hepatic resection. It is worthy of chinical application.
[Key words] Diabetics; Insulin; Hepatic resection
肝脏是人体维持糖代谢稳定的重要器官之一，糖原的储存、分解，与糖代谢有关的激素如胰岛素、胰高血糖素的分解等生理活动均在肝脏完成。因肝脏肿瘤行择期肝切除的患者，不仅多数合并慢性肝病、肝硬化，而且因麻醉、术中出血、肝脏缺血再灌注损伤等可造成术后肝功能损伤或肝功能不全。尤其是针对合并糖尿病的老年患者，肝切除术可加重患者的糖代谢紊乱。如何维持肝切除术后血糖稳定，降低术后并发症和死亡率是肝脏外科的临床治疗和护理的核心内容之一。为此，本研究分析了肝切除术后患者禁食期间胰岛素给药方式与血糖的关系。
1 资料与方法
1.1 一般资料
选择2008~2010年我院肝胆外科收治因肝脏肿瘤择期行肝切除术的糖尿病患者63例，其中，男42例，女21例；年龄25~88岁，平均(53.21±10.93)岁。术后病理证实原发性肝细胞癌55例，胆管细胞癌8例，其中，42例合并慢性乙型肝炎，6例合并慢性丙型肝炎。将63例患者随机分为胰岛素静脉滴注组(n=32例)和胰岛素静脉泵入组(n=31例) ......
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