胰岛素瘤切除术围手术期血糖监测的临床意义

【摘要】 目的 探讨胰岛素瘤切除术的围术期管理。方法 回顾性分析本院5年来通过手术治疗胰岛素瘤患者的临床资料。结果 18例患者中男6例,女12例,均有典型的Whipple三联征。15例行开放性肿瘤切除术,3例行腹腔镜下肿瘤切除术。开腹手术采用硬膜外麻醉复合气管内全麻,腹腔镜手术采用单纯气管内全麻。根据术中不同的血糖管理方式将患者分为两组:持续泵注组(C组,n=10)术中静脉泵注50%葡萄糖溶液,根据血糖调节输注速度,维持血糖在3.0~6.0 mmol·L-1;非持续泵注组(NC组,n=8)未予持续泵注葡萄糖,仅在血糖低于2.8 mmol·L-1时才静脉推注50%葡萄糖50 mL。术中每隔15分钟监测一次血糖,肿瘤切除前30 min停止给糖。所有患者术中患者生命体征平稳。持续泵注葡萄糖组肿瘤切除前后血糖控制较非持续泵注稳定(P<0.05)。结论 胰岛素瘤手术时采用持续泵注葡萄糖能够稳定手术过程中血糖水平,肿瘤切除前静脉泵注50%葡萄糖可以避免肿瘤切除前后血糖急剧波动。

Clinical value of blood sugar monitoring for perioperative period insulinoma resection

Objective To investigate the perioperative management for surgical removal of pancreatic insulinoma. Methods From November 2011 to October 2012 ,.the clinical data of 18 patients with insulinoma treated by surgical operation were analyzed retrospectively. Results Six male and 12 female patients with Whipple＇s triad were included into this study..Of 18 cases, fifteen patients received open tumor enucleation , and 3 cases received laparoscopic resection of the tumor. Patients underwent open surgery were anesthetized by general anesthesia combining with epidural block. .Those underwent laparoscopic surgery received general anesthesia only. The patients were divided into 2 groups：.C group （n=10）, patients received 50% GS continuous infusion and blood sugar was measured in every 15 min. 50% GS infusion ended 30 min before the removal of the tumor. NC group （n=8）, patients didn’t receive 50% GS continuous infusion but just received 50% GS 50 mL intravenous injection when blood sugar was lower than 2.8 mmol·L-1 . Vital signs were steady and blood sugar of patients in C group was controlled more stable than that NC group （P0.05）. Conclusion 50% GS infusion with repeat blood sugar monitoring intraoperatively would prevent dramatic hypoglycemia before and after tumor removal.