肝移植患者术后血糖调控方案的构建及应用  

Construction and application of blood glucose regulation scheme for postoperative liver transplant patients

作　　者：江方正 王芳 张双双 施旼艳 郑娴庆 王桂云 范杰梅 李百强 童智慧 李维勤 JIANG Fangzheng;WANG Fang;ZHANG Shuangshuang;SHI Minyan;ZHENG Xianqing;WANG guiyun;FAN Jiemei;LI Baiqiang;TONG Zhihui;LI Weiqin(Department of Intensive Care Medicine,2.Department of Nursing,Jinling Hospital,Affiliated Hospital of Medical School,Nanjing University/General Hospital of Eastern Theater Command,PLA,Nanjing 210002,Jiangsu,China)

机构地区：[1]南京大学医学院附属金陵医院(东部战区总医院)重症医学科,南京210002 [2]南京大学医学院附属金陵医院(东部战区总医院)护理部,南京210002

出　　处：《医学研究与战创伤救治》2024年第4期375-380,共6页Journal of Medical Research & Combat Trauma Care

基　　金：东部战区总医院院管课题(YYHL2021060)。

摘　　要：目的构建肝移植患者术后血糖调控方案并评价其应用效果。方法采用非同期前后对照研究。便利选择东部战区总医院2022年7-12月肝移植术后患者50例作为试验组,2022年1-6月行肝移植术后患者50例作为对照组,2组患者基线资料一致。试验组采取肝移植患者术后血糖调控方案,该方案基于循证、德尔菲专家咨询法构建,对血糖值区间、复测血糖值、较前次监测值变化、胰岛素调整方案、监测频次等给予详细说明。对照组采取常规血糖调控方案。比较2组肝移植患者术后血糖调控方案48 h内血糖波动幅度、血糖监测频率、胰岛素用量、血糖调控至目标范围内所需时间、稳定在目标范围内总时间、低血糖不良事件发生率。结果试验组干预48 h内在血糖波动幅度(8.77±3.64)mmol/L、胰岛素用量(72.82±55.19)U、血糖偏高调控至目标范围内所需时间(660.80±335.45)min、稳定在目标范围内总时间(1939.20±426.36)min,与对照组[(11.38±5.03)mmol/L、(98.84±66.82)U、(871.40±459.29)min、(1611.20±530.44)min]相比较,差异均有统计意义(P<0.05);试验组在术后48 h未发生低血糖,与对照组发生8例低血糖比较,差异有统计学意义(P<0.05);2组术后48 h内血糖监测频率的比较,差异无统计学意义(P>0.05)。结论肝移植患者术后血糖调控方案具备精准性、可行性和安全性,能改善肝移植患者术后血糖调控效果,促进患者术后快速康复。Objective To establish the blood glucose regulation scheme for postoperative liver transplant patients and evaluate its application effect.Methods The before-and-after control study was used.Fifty patients who underwent liver transplantation from July to December 2022 in Eastern Theater General Hospital were selected as the experimental group,and 50 patients who underwent liver transplantation from January to June 2022 were selected as the control group.The baseline data of the two groups were consistent.The experimental group adopted the blood glucose regulation scheme for liver transplantation patients after surgery,which was constructed based on evidence-based and Delphi expert consultation method.The blood glucose range,remeasured blood glucose value,changes from the previous monitoring value,insulin adjustment scheme and monitoring frequency were explained in detail.The control group received routine blood glucose regulation.The fluctuation amplitude of blood glucose,frequency of blood glucose monitoring,dosage of insulin,time required for blood glucose regulation to reach the target range,total time to stabilize within the target range,and incidence of adverse events of hypoglycemia were compared between the two groups.Results Within 48h of intervention,the blood glucose fluctuation range of the experimental group was(8.77±3.64)mmol/L,the dosage of insulin was(72.82±55.19)U,the time required for hyperglycemia regulation to reach the target range was(660.80±335.45)min,and the total time for stable within the target range was(1939.20±426.36)min.The control group was[(11.38±5.03)mmol/L,(98.84±66.82)U,(871.40±459.29)min,(1611.20±530.44)min],respectively,and the differences were statistically significant(P<0.05).No hypoglycemia occurred in the experimental group 48 h after surgery,while 8 cases of hypoglycemia occurred in the control group,with statistical significance(P<0.05).There was no significant difference in the frequency of blood glucose monitoring between the two groups within 48 h after operati

关 键 词：重症患者 肝移植 血糖管理 血糖控制 

分 类 号：R575[医药卫生—消化系统]