妇科恶性肿瘤合并糖尿病围手术期处理

目的 探索妇科恶性肿瘤合并糖尿病患者围手术期血糖控制的安全方法.比较胰岛素两种疗法对妇科恶性肿瘤合并糖尿病患者围手术期治疗效果.方法 对35例妇科恶性肿瘤合并糖尿病患者围手术期治疗进行回顾性分析,其中20例应用胰岛素泵(CSII)连续皮下给药,15例采用多次皮下胰岛素注射(MSII)给药方式.结果 两种疗法均能有效控制妇科恶性肿瘤合并糖尿病患者围手术期血糖.胰岛素泵连续注射比多次注射血糖达标时间短CSII(4.20±1.22)dvs MSII(6.02±1.36)d,(P＜0.05)],低血糖发生率低CSII10% vs MSII 33.33%,(P＜0.05)],术中及术后未进食阶段血糖波动小CSII(5.26±1.08)vs MSII(7.38±3.04),(P＜0.05)],术后并发感染和切口愈合不良并发症少(CSII 5% vs MSII 20%,P＜0.05).结论 两种疗法均能有效控制妇科恶性肿瘤合并糖尿病患者围手术期血糖.CSII比MSII更快、更有效地控制高血糖,并减少低血糖和感染的发生率.

Perioperative glycemic control in diabetic patients during gynecological malignant tumor surgery

Objective To determine the safe method of perioperative glycemic control in diabetic patients during gynecologicalmalignant tumor surgery and to compare the treating effect between two insulin use in controlling blood glucose. Methods 35cases with gynecological malignant tumor and diabetes mellitus underwenet operation from 2007 -2010 were retrospectively analyzed. 20 patients of them adopted continuous subcutaneous insulin infusion （CSII） pump and 15 patients of them adopted muhiple subcutaneous insulin infusion （MSII）. Results Two insulin use methods can both effectively control perioperative glycemic in diabetic patients during gynecological malignant tumor surgery. The time to ideal preoperative blood glucose in CSII is shorter than that in MSII（ CSII 4. 20 ±1.22 天 vs MSII 6. 02 ± 1.36天 ,P 〈0. 05） and the incidence of hypoglycemia in CSII is also lower than that in MSII（ CSII 10% vs MSII 33.33%, P 〈 0. 05 ）. The fluctuating level of blood glucose during operation and in inhibititng eating phase after operation in CSII is also less than that in MSII （ CSII 5.26 ± 1.08, MSII7.38± 3.04, P 〈 0. 05 ） and infection after operation or bad healing in incision in CSII is also less than that in MSII （ CSII 5% vs MSII 20%, P 〈 0. 05 ）. Conclusion Two insulin use methods can both effectively control perioperative glycemic in diabetic patients during gynecological malignant tumor cancer surgery. Controling blood glucose in CSII is faster and more effective than that in MSII and the incidence of hypoglycemia and infection after operation in CSII is also less than that in MSII.