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目的探讨持续皮下胰岛素输注治疗围手术期糖尿病患者的降糖效果及对术后并发症、住院天数和住院费用的影响。方法68例行大、中型手术的围手术期2型糖尿病患者,随机分为持续皮下输注胰岛素(continuous subcutaneous insulininfusion,CSII)组和每日多次皮下注射胰岛素(multiple subcutaneous in-sulininjection,MSII)组,两组均以空腹血糖3.9～7.0mmol/L,三餐后2h平均血糖<9.0mmol/L为预期控制目标。观察血糖控制情况、降糖费用、术前等待时间、住院天数、住院费用等。结果CSII组与MSII组入院时空腹及餐后2h血糖无明显差异(P>0.05),术前空腹及餐后2h血糖有明显差异(P<0.05),术后前两日平均血糖和拆线日空腹血糖有明显差异(P<0.005),CSII组在术前等待时间、住院天数上明显少于MSII组,在降糖费用明显高于MSII组(P<0.001),而在住院费用上与MSII组无明显差异(P>0.05),MSII组有1例发生切口感染、2例切口延迟愈合与CSII组比较无明显差异(P>0.10),两组低血糖发生次数的比较有明显差异(P<0.005)。结论围手术期糖尿病患者应用CSII治疗,可迅速改善糖代谢状况,缩短血糖达标时间、术前等待时间、住院时间,医疗总费用并未明显增加。故对围手术期糖尿病患者使用CSII治疗是控制血糖、纠正代谢紊乱的的最佳方法,特别是原有血糖控制较差时的首选。
Objective To investigate the hypoglycemic effects of continuous subcutaneous insulin infusion in patients with perioperative diabetes mellitus and its influence on postoperative complications, hospitalization days and hospitalization costs. Methods Sixty-eight patients with perioperative type 2 diabetes mellitus undergoing large and medium operation were randomly divided into continuous subcutaneous insulin infusion (CSII) group and multiple subcutaneous in-sulininjection (MSII) Group, the two groups were fasting blood glucose 3.9 ~ 7.0mmol / L, after meals, 2h average blood glucose <9.0mmol / L for the expected control target. Observed blood glucose control, hypoglycemic costs, preoperative waiting time, hospitalization days, hospitalization fees and so on. Results There were no significant differences in fasting and postprandial blood glucose between the CSII group and the MSII group 2h after admission (P> 0.05). There was a significant difference in fasting and 2h postprandial blood glucose between the CSII group and the MSII group (P <0.05) (P <0.005). The preoperative waiting time and hospital stay of CSII group were significantly less than that of MSII group, and the cost of hypoglycemia was significantly higher than that of MSII group (P <0.001) There was no significant difference between MSII group and MSII group (P> 0.05). In MSII group, one case had incision infection and two cases had delayed union. There was no significant difference between the two groups (P> 0.10) P <0.005). Conclusion Perioperative diabetes patients with CSII treatment can rapidly improve glucose metabolism, shorten the blood glucose compliance time, preoperative waiting time, hospital stay, the total cost of medical care did not increase significantly. Therefore, the use of CSII for perioperative diabetic patients is the best way to control blood sugar and correct metabolic disorders, especially when the original blood glucose control is poor.