摘要
目的：对全胰腺切除术后患者的血糖特点及胰岛素用量进行评估分析。方法回顾性分析北京协和医院1980年9月至2014年9月共21例全胰腺切除术患者的围术期胰岛素用量及血糖变化，稳定期胰岛素种类、用量及血糖变化，并总结其特点。结果患者术后4d内胰岛素需求量达峰值（最大日用量300 U），平均（143．5±62．8） U／d，然后逐渐下降；围术期（需肠外营养）血糖波动大（1．52～29．06 mmol／L），平均（11．18±0．95） mmol／L。稳定期（脱离肠外营养）非应激状态下，患者每天餐前短效或速效胰岛素用量平均（5．3±2．0） U，睡前长效胰岛素平均（8．1±2．9） U；平均空腹血糖（6．69±1．48） mmol／L，三餐后2 h血糖（9．08±2．84） mmol／L，睡前血糖（9．66±2．49） mmol／L，夜间血糖（8．15±2．78） mmol／L；67％患者平均1个月内发生13次低血糖。5例随访患者平均糖化血红蛋白为（6．15±1．20）％。结论全胰腺切除术后患者围术期血糖波动大，胰岛素需求短暂升高，然后逐渐下降，稳定期可维持较低水平，血糖控制良好，但常有低血糖发生，无酮症酸中毒。
Objective To evaluate the post-operative glucose level and insulin dose of patients undergoing total pancreatectomy.Methods From September 1980 to September 2014, 21 patients underwent total pancrea-tectomy in Peking Union Medical College Hospital, who were enrolled in our study.We reviewed the changes in their insulin dosage and glucose levels after operation, also summarized type and dose of insulin as well as glucose level in stable period.Results The required insulin dose reached peak within 4 days after surgery （ maximum dose 300 U/d）.The average dose was （143.5 ±62.8） U/d and decreased gradually.During the perioperative period （needing parenteral nutrition）, the blood glucose level fluctuated markedly （1.52-29.06 mmol/L） and the average level was （11.18 ±0.95） mmol/L.During the stable period （ without parenteral nutrition） , patients on average had （5.3 ±2.0） U of preprandial rapid-acting insulin and （8.1 ±2.9） U of long-acting insulin be-fore sleeping;the average fasting blood glucose was （6.69 ±1.48） mmol/L, 2 h postprandial blood glucose was （9.08 ±2.84） mmol/L, bedtime blood glucose was （9.66 ±2.49） mmol/L, and blood glucose level at night was （8.15 ±2.78） mmol/L.67%of the patients had 13 hypoglycemic episodes monthly on average.For those five followed-up patients, the average hemoglobin A1c was （6.15 ±1.20）%.Conclusions Patients undergoing total pancreatectomy may experience marked fluctuation of blood glucose level and short-term increase of insulin＆amp;nbsp;need which gradually decreases afterwards.After entering the stable period, the glucose level could be well-con-trolled but with frequent hypoglycemia.There is no diabetic ketoacidosis.
出处
《中华临床营养杂志》
CAS
CSCD
2016年第2期70-75,共6页
Chinese Journal of Clinical Nutrition
关键词
全胰腺切除术
血糖监测
连续血糖监测
胰岛素剂量
Total pancreatectomy
Blood glucose monitor
Continuous glucose monitoring
Insu-lin dosage
Total pancreatectomy
Blood glucose monitor
Continuous glucose monitoring
Insu-lin dosage
