胰腺手术患者的围手术期血糖控制

目的探讨胰腺手术患者的围手术期血糖控制与手术并发症发生的相关性。方法回顾性分析1995年1月至2010年4月共412例行胰十二指肠切除术患者的临床资料，分析围手术期血糖控制及术后并发症发生情况。结果胰腺术后患者平均空腹血糖水平均高于正常，术后应用胰岛素可以有效控制血糖。术后空腹血糖〉8．3mmol／L的患者死亡率、术后胰漏、出血、感染等严重并发症的发生率（7．O％、23．7％、9．7％、15．1％）显著高于术后空腹血糖≤8．3mmol／L的患者（2．7％、11．9％、4．0％、6．6％）（P=0．037、P=0．002、P=0．020、P=0．005）。术后空腹血糖≤6．1mmol／L的患者死亡率和术后出血的发生率（6．2％、8．6％）显著高于术后空腹血糖6．1-8．3mmol／L的患者（0．7％、1．4％）（P=0．023、P=0．011）。术后空腹血糖≤6．1mmol／L的患者发生严重低血糖的情况显著增加（7．4％比0．7％，P=0．009）。结论通过术后持续静脉滴注葡萄糖＋普通胰岛素治疗可以有效平稳控制血糖，实现围手术期预定目标下的血糖管理。胰腺手术围手术期的目标血糖定为6．1～8．3mmol／L是安全合理的，能够减少术后并发症和降低死亡率。

Perioperative glycemic control in patients undergoing pancreatic surgery

Objective To explore the association between perioperative glycemic control and the post-operative complications of patients undergoing pancreatic surgery. Method The clinical data of 412 patients who underwent pancreatoduodenectomy between January 1995 and April 2010 were retrospectively analyzed. Results The average fasting glycemic level was significantly higher than normal postoperatively, and the post-operative application of insulin effectively controlled glycemic levels. The rates of postoperative mortality, pancreatic fistula, hemorrhage, and infections among patients with glucose level 〉 8. 3 mmol/L （7. 0%, 23. 7%, 9..7%, and 15.1% ） were significantly higher than those with glucose level ≤8.3 mmol/L （2. 7%, 11.9%, 4. 0%, and 6. 6% ） （ P = 0. 037, P = 0. 002, P = 0. 020, and P = 0. 005 ）. On the contrary, the rates of postoperative mortality and hemorrhage among patients with glucose level ≤6. 1 mmol/L （6. 2% and 8.6% ） were significantly higher than those with glucose level between 6. 1 and 8.3 mmol/L （0. 7% and 1.4% ） （ P = 0. 023 and P = 0. 011 ）. The rate of hypoglycemia was significantly higher in patients with glucose level≤6.1 mmol/L （7.4% vs. 0.7%, P = 0. 009）. Conclusions Postoperative glucose level can be stably controlled by continuous intravenous glucose infusion plus regular insulin therapy. A target perioperative glucose level between 6. 1 and 8.3 mmol/L can effectively and safely reduce postoperative mortality and complications.