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
|
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 significant(P<0.05).Conclusion Compared with CIIT,BGCOP can more effectively control blood sugar levels in patients with SHG after hepatobiliary surgery.
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 significant(P<0.05).Conclusion Compared with CIIT,BGCOP can more effectively control blood sugar levels in patients with SHG after hepatobiliary surgery.
引文
[1]YAN C,QIN M,JUAN YS,et al.Association of statin use and stress-induced hyperglycemia in patients with acute ST-elevation myocardial infarction[J].JRSM Cardiovasc Dis,2016,5:2048004016639442.DOI:10.1177/2048004016639442.
[2]ALIZADEH N,KHALILI H,MOHAMMADI M,et al.Effect of vitamin D on stress-induced hyperglycaemia and insulin resistance in critically ill patients[J].Int J Clin Pract,2016,70(5):396-405.
[3]MARIK PE,BELLOMO R.Stress hyperglycemia:an essential survival response![J].Crit Care Med,2013,41(6):e93-e94.DOI:10.1097/CCM.0b013e318283d124.
[4]SCURLOCK C,RAIKHELKAR J,MECHANICK JI.Critique of normoglycemia in intensive care evaluation:survival using glucose algorithm regulation(NICE-SUGAR)-a review of recent literature[J].Curr Opin Clin Nutr Metab Care,2010,13(2):211-214.
[5]DELLINGER RP,LEVY MM,RHODES A,et al.Surviving Sepsis Campaign:international guidelines for management of severe sepsis and septic shock,2012[J].Intensive Care Med,2013,39(2):165-228.
[6]HARP JB,YANCOPOULOS GD,GROMADA J.Glucagon orchestrates stress-induced hyperglycaemia[J].Diabetes Obes Metab,2016,18(7):648-653.
[7]GRECO G,FERKET BS,D'ALESSANDRO DA,et al.Diabetes and the association of postoperative hyperglycemia with clinical and economic outcomes in cardiac surgery[J].Diabetes Care,2016,39(3):408-417.
[8]CHEN Y,ZHANG Y,JI H,et al.Involvement of hypoxia-inducible factor-1alpha in the oxidative stress induced by advanced glycation end products in murine Leydig cells[J].Toxicol In Vitro,2016,32:146-153.
[9]KUMAR P,RAMAN T,SWAIN MM,et al.Hyperglycemia-induced oxidative-nitrosative stress induces inflammation and neurodegeneration via augmented tuberous sclerosis complex-2(TSC-2)activation in neuronal cells[J].Mol Neurobiol,2017,54(1):238-54.
[10]VOGELZANG M,VAN DER HORST IC,NIJSTEN MW.Hyperglycaemic index as a tool to assess glucose control:a retrospective study[J].Crit Care,2004,8(3):R122-R127.
[11]MRAOVIC B,SUH D,JACOVIDES C,et al.Perioperative hyperglycemia and postoperative infection after lower limb arthroplasty[J].J Diabetes Sci Technol,2011,5(2)412-418.
[12]YAMAZAKI Y,OGIHARA S,HARADA S,et al.Activation of cerebral sodium-glucose transporter type 1 function mediated by postischemic hyperglycemia exacerbates the development of cerebral ischemia[J].Neuroscience,2015,310:674-685.
[13]BOSARGE PL,SHOULTZ TH,GRIFFIN RL,et al.Stress-induced hyperglycemia is associated with higher mortality in severe traumatic brain injury[J].J Trauma Acute Care Surg,2015,79(2):289-294.
[14]KONG JG,PARK JB,LEE D,et al.Effect of high glucose on stress-induced senescence of nucleus pulposus cells of adult rats[J].Asian Spine J,2015,9(2):155-161.
[15]BOILLAT-BLANCO N,RAMAIYA KL,MGANGA M,et al.Transient hyperglycemia in patients with tuberculosis in tanzania:Implications for diabetes screening algorithms[J].J Infect Dis,2016,213(7):1163-1172.
[16]YANG P,ZHAO Y,ZHAO L,et al.Paradoxical effect of rapamycin on inflammatory stress-induced insulin resistance in vitro and in vivo[J].Sci Rep,2015,5:14959.
[17]AL-MALKI AL,BARBOUR EK,ABULNAJA KO,et al.Management of hyperglycaemia by ethyl acetate extract of balanites aegyptiaca(Desert Date)[J].Molecules,2015,20(8):14425-14434.
[18]DAVIDSON P,KWIATKOWSKI CA,WIEN M.Management of hyperglycemia and enteral nutrition in the hospitalized patient[J].Nutr Clin Pract,2015,30(5):652-659.
[2]ALIZADEH N,KHALILI H,MOHAMMADI M,et al.Effect of vitamin D on stress-induced hyperglycaemia and insulin resistance in critically ill patients[J].Int J Clin Pract,2016,70(5):396-405.
[3]MARIK PE,BELLOMO R.Stress hyperglycemia:an essential survival response![J].Crit Care Med,2013,41(6):e93-e94.DOI:10.1097/CCM.0b013e318283d124.
[4]SCURLOCK C,RAIKHELKAR J,MECHANICK JI.Critique of normoglycemia in intensive care evaluation:survival using glucose algorithm regulation(NICE-SUGAR)-a review of recent literature[J].Curr Opin Clin Nutr Metab Care,2010,13(2):211-214.
[5]DELLINGER RP,LEVY MM,RHODES A,et al.Surviving Sepsis Campaign:international guidelines for management of severe sepsis and septic shock,2012[J].Intensive Care Med,2013,39(2):165-228.
[6]HARP JB,YANCOPOULOS GD,GROMADA J.Glucagon orchestrates stress-induced hyperglycaemia[J].Diabetes Obes Metab,2016,18(7):648-653.
[7]GRECO G,FERKET BS,D'ALESSANDRO DA,et al.Diabetes and the association of postoperative hyperglycemia with clinical and economic outcomes in cardiac surgery[J].Diabetes Care,2016,39(3):408-417.
[8]CHEN Y,ZHANG Y,JI H,et al.Involvement of hypoxia-inducible factor-1alpha in the oxidative stress induced by advanced glycation end products in murine Leydig cells[J].Toxicol In Vitro,2016,32:146-153.
[9]KUMAR P,RAMAN T,SWAIN MM,et al.Hyperglycemia-induced oxidative-nitrosative stress induces inflammation and neurodegeneration via augmented tuberous sclerosis complex-2(TSC-2)activation in neuronal cells[J].Mol Neurobiol,2017,54(1):238-54.
[10]VOGELZANG M,VAN DER HORST IC,NIJSTEN MW.Hyperglycaemic index as a tool to assess glucose control:a retrospective study[J].Crit Care,2004,8(3):R122-R127.
[11]MRAOVIC B,SUH D,JACOVIDES C,et al.Perioperative hyperglycemia and postoperative infection after lower limb arthroplasty[J].J Diabetes Sci Technol,2011,5(2)412-418.
[12]YAMAZAKI Y,OGIHARA S,HARADA S,et al.Activation of cerebral sodium-glucose transporter type 1 function mediated by postischemic hyperglycemia exacerbates the development of cerebral ischemia[J].Neuroscience,2015,310:674-685.
[13]BOSARGE PL,SHOULTZ TH,GRIFFIN RL,et al.Stress-induced hyperglycemia is associated with higher mortality in severe traumatic brain injury[J].J Trauma Acute Care Surg,2015,79(2):289-294.
[14]KONG JG,PARK JB,LEE D,et al.Effect of high glucose on stress-induced senescence of nucleus pulposus cells of adult rats[J].Asian Spine J,2015,9(2):155-161.
[15]BOILLAT-BLANCO N,RAMAIYA KL,MGANGA M,et al.Transient hyperglycemia in patients with tuberculosis in tanzania:Implications for diabetes screening algorithms[J].J Infect Dis,2016,213(7):1163-1172.
[16]YANG P,ZHAO Y,ZHAO L,et al.Paradoxical effect of rapamycin on inflammatory stress-induced insulin resistance in vitro and in vivo[J].Sci Rep,2015,5:14959.
[17]AL-MALKI AL,BARBOUR EK,ABULNAJA KO,et al.Management of hyperglycaemia by ethyl acetate extract of balanites aegyptiaca(Desert Date)[J].Molecules,2015,20(8):14425-14434.
[18]DAVIDSON P,KWIATKOWSKI CA,WIEN M.Management of hyperglycemia and enteral nutrition in the hospitalized patient[J].Nutr Clin Pract,2015,30(5):652-659.