不同血糖控制目标对腹部手术后重症应激性高血糖影响的对照研究

目的：探讨不同血糖控制目标对腹部术后重症应激性高血糖影响。方法选择开腹部术后发生应激性高血糖患者76例，随机分为A组和B组，每组38例，A组和B组分别以（7.8-10.0）mmol/L和（4.5-8.3）mmol/L作为血糖控制目标，采用相同胰岛素干预方案，对比两组血糖达标时间、生化指标、血糖控制不良反应、并发症、住院时间。结果 A组和B组血糖控制达标时间比较，差异有统计学意义（P〈0.05），A组在术后72 h内血糖均逐渐降至正常范围内，A组降钙素原和C反应蛋白值显著低于B组（P〈0.05），两组均未发生高渗性昏迷，A组低血糖和严重低血糖发生率显著低于B组（P〈0.05），两组均无死亡病例，两组切口感染、腹腔感染、肺部感染、败血症及住院时间比较，差异均无统计学意义（P〉0.05）。结论腹部手术后应激性高血糖患者血糖控制在（7.8-10.0）mmol/L范围更有利于减轻患者术后机体免疫系统应激反应，降低低血糖发生率，并不增加术后感染发生，具有良好的术后获益和安全性。

Control study of different blood glucose control on severe stress hyperglycemia goal after abdominal surgery

Objective To explore the different stress hyperglycemia blood sugar control target of the impact of severe abdominal surgery. Methods Chose open abdominal postoperative stress hyperglycemia 76 patients were randomly di-vided into group A and group B, each of 38 cases, A and B, respectively, to 7.8-10.0 mmol/L or 5.6-8.3 mmol/L as glycemic control targets, used the same insulin intervention programs, compared two groups of blood glucose time,biochemical parameters, glycemic control adverse reactions, complications, length of hospital stay. Results A group and B group blood sugar control standard time,the differences were statistically significant （P〈0.05）, A group within 72h after surgery were gradually reduced blood sugar within normal range, A group of procalcitonin and C-reactive protein values were significantly lower than group B （P〈0.05）, the two groups did not occur hyperosmolar coma , A group of hypoglycemia and severe hypoglycemia were significantly lower than group B （P〈0.05）, were no deaths ,wound infection, abdominal infections, lung infections, sepsis, incidence of death and hospitalization time , the dif-ferences were not statistically significant（P〉0.05）. Conclusion Abdominal surgery in patients with stress hyperglycemia blood sugar control in 6.0-10.0 mmol/L range were more conducive to the body＇s immune system to reduce postopera-tive stress response, reduce the incidence of hypoglycemia, does not increase postoperative infection, with good post-operative benefit and safety.