| | | 持续皮下胰岛素输注在糖尿病患者围手术期应用价值的评估
| | 西医学 评职称论文【关键词】 胰岛素；注射,皮下；手术期间
Value of continuous subcutaneous insulin infusion during perioperation of diaketic patients
【Abstract】 AIM: To assess the effect of continuous subcutaneous insulin infusion (CSII) during perioperation in diabetic patients. METHODS: Eightyseven diabetic patients in perioperation who need insulin therapy were randomly divided into CSII group (n=46, 2 T1DM and 44 T2DM) and multiple subcutaneous insulin infusion (MSII) group (n=41, 3 T1DM and 38 T2DM). The target of blood glucose control was 3.9-7.9 mmol/L. The time of blood glucose for achieving the target, and preoperative preparation time, length of stay, success rate of preoperative blood glucose control, glucose level at 3 rd day of insulin treatment, expense for preoperative glucose control and total expense of hospitalization were compared between the 2 groups. RESULTS: The time of blood glucose for achieving the target in CSII group［(2.2±1.6)d］was shorter than that in MSII group［(8.5±4.8) d, P<0.01］;the time of preoperative preparation in CSII group ［(4.6±3.2) d］ was shorter than that in MSII group ［(11.8±6.8) d, P<0.01］; the length of stay in CSII group［(19.6±9.4) d］was also shorter than that in MSII ［(26.2±10.0) d, P<0.01］;the success rate of preoperative blood glucose control in CSII group was 85.4%, higher than that in MSII (53.2%, P<0.01). Fasting glucose level at 3 rd day of insulin treatment in CSII group ［(7.5±1.8) mmol/L］ was lower than that in MSII ［(10.5±2.6) mmol/L, P<0.01］. All of above results proved that CSII could help to obtain better glucose control. Although expense for preoperative glucose control in CSII group ［(867.9±574.4) RMB］ was higher than that in MSII ［(497.9±283.6) RMB, P<0.01］, total expense of hospitalization in CSII group ［(25007±18048) RMB］ was almost as much as that in MSII ［(24919±21617)RMB, P>0.05). CONCLUSION: The application of CSII in preoperation of diabetic patients can bring better glucose control and shorten hospitalization time, therefore the total expense of hospitalization is not increased.
【Keywords】 insulin; injections subcutaneous; intraoperative period
【摘要】 目的西医学 评职称论文： 评估持续皮下输注胰岛素(CSII)在围手术期糖尿病患者中的西医学 评职称论文降糖效果和医疗经济学指标. 方法： 胰岛素治疗的围手术期糖尿病患者87例，随机分为CSII组（46例，T1 DM 2例，T2 DM 44例）和胰岛素分次皮下注射(MSII)组(41例，T1 DM 3例，T2 DM 38例)；2组靶血糖值为3.9~7.9 mmol/L. 观察2组的血糖达标时间、术前准备时间、住院日、术前血糖达标率、治疗3d时血糖水平以及术前降糖费用和住院总费用. 结果： CSII和MSII 2组间的血糖达标时间（d,2.2±1.6 vs 8.5±4.8, P<0.01），术前准备时间（d,4.6±3.2 vs 11.8±6.8, P<0.01），住院日（d, 19.6±9.4 vs 26.2±10.0, P<0.01），术前血糖达标率（85.4% vs 53.2%, P<0.01）、治疗3d时空腹血糖水平［(7.5±1.8) mmol/L vs (10.5±2.6) mmol/L, P<0.01］，CSII组在降糖方面明显优于MSII组，CSII组的术前降糖费用高于MSII组（元，867.9±574.4 vs 497.9±283.6, P<0.01），但2组间的住院总费用（元，25007±18048 vs 24919±21617, P>0.05）无差异. 结论： 糖尿病患者围手术期进行持续皮下胰岛素输注，在不增加住院总费用的基础上可带来更好的血糖控制，并缩短住院时间.
【关键词】 胰岛素；注射，皮下；手术期间
0引言
随着糖尿病患病率的不断增高，因各种疾病而需手术治疗的糖尿病患者也日渐增多. 这一部分患者术前准备、术中处理及术后康复等过程相对复杂，往往导致患者术前准备时间及住院时间延长，住院费用明显高于非糖尿病患者［1］. 而且，患者围手术期血糖控制程度直接影响着手术治疗的预后. 在经济欠发达的西北地区，有些患者因术前血糖难以达标，或治疗费用增加而丧失了手术机会. 因此，加强糖尿病患者围手术期血糖控制、节约医疗开支，是一个值得关注的课题. 为了解西北地区围手术期糖尿病患者的有效降糖方法和降糖相关的医疗经济学指标，本文对我院手术科室住院糖尿病患者应用持续皮下胰岛素输注 (continuous subcutaneous insulin infusion, CSII)，胰岛素分次皮下注射 (multiple subcutaneous insulin injection, MSII)进行胰岛素治疗的主要血糖控制指标和医疗费用指标进行了分析.
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