血糖控制优化方案在肝胆外科术后应激性高血糖病人中的应用  

Application of blood glycaemic control optimization programme in patients with stress hyperglycaemia after hepatobiliary surgery

作　　者：郭伟[1] 李小臣 李慧[1] 曹丽[1] 李娜[1] 仰曙芬[2] GUO Wei;LI Xiaochen;LI Hui;CAO Li;LI Na;YANG Shufen(Department of Hepatobiliary Surgery,Qilu Hospital of Shandong University,Jinan,Shandong250000,China;School of Nursing,Harbin Medical University,Harbin,Heilongjiang 150001,China)

机构地区：[1]山东大学齐鲁医院肝胆外科,山东济南250000 [2]哈尔滨医科大学护理学院,黑龙江哈尔滨150001

出　　处：《安徽医药》2019年第8期1566-1569,共4页Anhui Medical and Pharmaceutical Journal

基　　金：哈尔滨医科大学技术项目(2014-B18)

摘　　要：目的探讨血糖控制优化方案(BGCOP)在肝胆外科术后应激性高血糖(SHG)病人中的应用效果。方法采用简单化随机分组法将2015年1-12月山东大学齐鲁医院86名符合条件的肝胆外科病人分为试验组(43例)和对照组(43例)。试验组采取BGCOP控制血糖,对照组采取常规胰岛素强化治疗方案(CIIT)控制血糖。比较术后两组病人的血糖控制效果、不良反应发生率和并发症发生率。结果两组病人的一般资料在年龄、体质指数(BMI)、急性生理与慢性健康评分(APACHE)等方面差异无统计学意义(P>0.05),对后续研究没有影响。试验组采取BGCOP方案后血糖控制到目标值的时间为(4.54±1.51) h,对照组采用CIIT方案后血糖控制到目标值的时间为(8.54±2.68) h,试验组采用BGCOP方案后血糖控制到目标值的时间明显低于对照组,高血糖指数(0.86±0.24)也明显低于对照组(1.97±0.94),差异有统计学意义(t=8.724,t=7.895,P<0.001);试验组病人50%葡萄糖救援、低血糖、严重低血糖发生率明显低于对照组,均差异有统计学意义(P<0.05);两组病人发生高渗性昏迷的比率差异无统计学意义(P>0.05);试验组病人发生肺部感染、腹部感染和切口感染的比率明显低于对照组病人,差异有统计学意义(P<0.05)。结论与CIIT相比,BGCOP方案能更有效地控制肝胆外科术后SHG病人的血糖水平。Objective To investigate the clinical effects of blood glycaemic control optimization programme(BGCOP) in patients with stress hyperglycaemia(SHG) after hepatobiliary surgery.Methods Eighty-six patients with postoperative SHG in Qilu Hospital of Shandong University from January to December 2015 were randomly assigned into the control group and the experimental group according to simple randomization method,with 43 cases in each group.Participants in the control group underwent conventional insulin intensive treatment(CIIT),while participants in the experimental group underwent BGCOP.The blood glucose control effect,the incidence of adverse reactions and the incidence of complications were compared between the two groups.Results There were not statistically differences in the age,body mass index(BMI),acute physiology and chronic health score(APACHE) value,which had no effect on subsequent studies(P>0.05).after the BGCOP program was adopted in the experimental group,the time of blood glucose control to the target value was(4.54±1.51) h,and after the CIIT program as adopted in the control group,the time of blood glucose control to the target value was(8.54±2.68) h.Compared with participants treated with CIIT,the time to the target value of participants treated with BGCOP was significantly lower than that of the control group,and the high glycemic index was also significantly lower than that of the control group(0.86±0.24 vs.1.97±0.94),and the difference was statistically significant(t=8.724,t=7.895,P<0.05).The incidence of 50% glucose rescue,hypoglycemia,and severe hypoglycemia in the experimental group was significantly lower than those in the control group,and the difference was statistically significant(P<0.05).And there was no significant difference in the rate of hyperosmolar coma between the two groups(P>0.05).The rates of pulmonary infection,abdominal infection and wound infection in the experimental group were significantly lower than those in the control group,and the difference was statistically signif

关 键 词：高血糖症 手术后并发症 消化系统外科手术/副作用 胰岛素输注系统 应激 生理学 胰岛素 应激性高血糖 

分 类 号：R657.3[医药卫生—外科学] R657.4[医药卫生—临床医学]