风湿性心脏病伴糖尿病患者瓣膜置换术后血糖控制护理体会

目的总结风湿心脏瓣膜病伴糖尿病瓣膜置换术后患者血糖的监测方法,预防术后因血糖异常导致的术后并发症,减轻痛苦,促进康复。方法回顾分析2011年4月-2012年3月收治的瓣膜置换伴发糖尿病的患者资料,随机抽取术后采用微量泵静脉泵入胰岛素治疗（观察组）和皮下注射胰岛素治疗（对照组）的患者各40例。对照组患者遵医嘱术后皮下注射胰岛素治疗;观察组患者术后则予微量泵静脉泵入胰岛素治疗,根据血糖水平及时调整胰岛素用量。收集并分析两组患者术后血糖水平变化和并发症的发生情况。结果观察组使血糖达标的胰岛素用量、血糖达标时间、住院时间、术后并发症的发生率均低于对照组,差异有统计学意义（P〈0.05）。术后随访1年,观察组与对照组分别有2例和4例患者死亡,病死率差异无统计学意义（χ2=0.180,P=0.670）。结论对心脏瓣膜置换伴发糖尿病的患者术后严密监测血糖,应用微量泵静脉泵入胰岛素,做好胰岛素运用、相关并发症、心理及饮食的护理,利于缩短住院时间,减少并发症的发生,改善患者预后。

Nursing Experience of Glycemic Control for Patients with Rheumatic Heart Disease Combined with Diabetes after Valve Replacement

Objective To summarize the monitoring experiences of blood glucose for patients with rheumatic heart disease combined with diabetes, in order to prevent postoperative complications caused by abnormal blood sugar, relieve pain and promote rehabilitation. Methods We reviewed the medical records of the patients with diabetes after heart valve replacement who were admitted to our department from April 2011 to March 2012. Eighty patients were randomly divided into observation group and control group with 40 in each group. Patients in the control group received conventional treatment with subcutaneous insulin injection, while the observation group patients were treated with intravenous insulin pump, and the dose of insulin was adjusted depending on blood glucose levels. Then we compared the postoperative changes in blood glucose level and complications between the two groups. Results The insulin dose, the time of reaching target blood glucose levels, hospital stays and postoperative complication rates were significantly lower in the observation group than the control group（P 〈 0.05）. During the one-year follow-up after operations, 2 and 4 patients died respectively in the observation group and the control group, and the difference was not significant（χ2=0.180, P=0.670）. Conclusions For patients with diabetes after heart valve replacements, intravenous insulin pump is better than subcutaneous insulin injection. It can prevent complications, shorten hospital stays, reduce financial burden, and promote prognosis and harmonious doctor-patient relationship.