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目的探讨接受肠外营养支持的腹部中等以上手术的糖尿病患者两种血糖调控方式的有效性和安全性。方法回顾性分析27例接受腹部中等以上手术的糖尿病患者术后使用肠外营养时的血糖监测结果,将其血糖调控方式分为将胰岛素按比例加入营养液(全合一法,IPN)和胰岛素静脉微量泵入法(IIM),分别比较2种血糖调控方式的晨间和全部血糖中位数、最大血糖波动幅度(LAGE)、低血糖和高血糖事件的发生率、血糖达标率。结果糖尿病患者使用TNA第2、3、4、5天晨间血糖中位数IIM组比IPN组低,其中第2、3、5天的差异具有统计学意义(P<0.05);2组全部血糖的中位数IIM组比IPN组低,差异具有统计学意义(P<0.01)。IIM组的LAGE值均小于IPN组,其中第1、2、3天差异具有统计学意义(P<0.01)。IIM组的高血糖事件发生率低于IPN组,且具有显著性差异(P<0.01),而低血糖事件发生率及达标率差异无统计学意义(P>0.05)。结论腹部中等以上术后肠外营养输注期间,糖尿病患者IIM血糖调控方式优于IPN。
Objective To investigate the efficacy and safety of two kinds of blood glucose control methods in patients with moderate or moderate abdominal surgery under parenteral nutrition support. Methods A retrospective analysis of 27 cases of diabetes mellitus patients undergoing moderate abdominal surgery with postoperative parenteral nutrition blood glucose monitoring results will be divided into its blood glucose regulation of insulin in proportion to the nutritional solution (all in one method, IPN) and insulin Intravenous microinjection method (IIM) were used to compare the morning and whole blood glucose median, the maximum blood glucose fluctuation range (LAGE), the incidence of hypoglycemia and hyperglycemia events, and the blood glucose compliance rate of the two kinds of blood glucose control methods respectively. Results In the first, second, third, fourth and fifth day of diabetes patients, the IIM group was lower than the IPN group in the morning, the difference was statistically significant (P <0.05) Median blood glucose IIM group than the IPN group, the difference was statistically significant (P <0.01). The LAGE values of IIM group were less than that of IPN group, with the difference between the first and second day being statistically significant (P <0.01). The incidence of hyperglycemia in IIM group was lower than that in IPN group (P <0.01), while the incidence of hypoglycaemia and compliance rate was not significantly different (P> 0.05). Conclusion During the period of mid-abdominal postoperative parenteral nutrition infusion, the blood glucose level of IIM in diabetic patients is better than that of IPN.