中华消化外科杂志
中華消化外科雜誌
중화소화외과잡지
CHINESE JOURNAL OF DIGESTIVE SURGERY
2012年
4期
327-330
,共4页
焦作义%尚轶%罗长江%俞泽元%周辉年%赵斌%李玉民
焦作義%尚軼%囉長江%俞澤元%週輝年%趙斌%李玉民
초작의%상질%라장강%유택원%주휘년%조빈%리옥민
重症急性胰腺炎%预后%胰岛素
重癥急性胰腺炎%預後%胰島素
중증급성이선염%예후%이도소
Severe acute pancreatitis%Prognosis%Insulin
目的 比较早期强化胰岛素治疗与适度胰岛素治疗对重症急性胰腺炎(SAP)患者预后的影响.方法 回顾性分析2005年1月至2009年12月兰州大学第二医院普通外科收治的78例SAP合并高血糖症患者的临床资料.根据治疗方案,分为强化组(31例)和适度组(47例),强化组维持血糖在0.80～ 1.10 g/L(4.4 ～6.1 mmol/L),而适度组维持血糖在1.44～1.80 g/L(8.0 ～ 10.0 mmol/L),比较两种血糖控制策略对患者预后的影响.计量资料采用t检验,计数资料采用x2检验.结果 两组患者接受胰岛素治疗情况:(1)血糖控制:强化组平均每日胰岛素用量为(35 ±11)u,平均晨测空腹血糖为(1.02 ±0.13) g/L[ (5.7±0.7)mmol/L],10％(3/31)的患者发生严重低血糖症;适度组平均每日胰岛素用量为(24±15)u,平均晨测空腹血糖为(1.58 ±0.21) g/L[ (8.8±1.2) mmol/L],2％ (1/47)的患者发生严重低血糖症.两组患者平均每日胰岛素用量比较,差异有统计学意义(t=12.76,P＜0.05);而两组患者严重低血糖症发生率比较,差异无统计学意义(x2=0.91,P ＞0.05).(2)营养指标:强化组和适度组患者入院第14天的Alb分别为(34 ±6)g/L和(35 ±5) g/L,前白蛋白分别为(231 ±31) mg/L和(241±29) mg/L,两组比较,差异无统计学意义(t=-1.94,-1.68,P＞0.05).(3)临床预后:强化组和适度组患者腹腔感染、循环障碍、呼吸障碍、获得性肾功能损害发生率分别为23％(7/31)、32％( 10/31)、26％(8/31)、13％(4/31)和26％(12/47)、36％(17/47)、30％( 14/47)、23％(11/47),入院第14天APPACHEⅡ评分分别为(9±4)分和(9±3)分,两组患者4种并发症发生率和APPACHEⅡ评分比较,差异均无统计学意义(x2=0.09,0.13,0.15,1.33,t=-0.60,P＞0.05).强化组和适度组分别有13％(4/31)和15％(7/47)的患者因MODS死亡,其中强化组2例、适度组6例合并脓毒症.两组患者病死率比较,差异无统计学意义(x2=0,P＞0.05).结论 与适度胰岛素治疗比较,早期强化胰岛素治疗并不能显著改善SAP患者的预后,SAP高血糖症患者实施适度胰岛素治疗是合理可行的.
目的 比較早期彊化胰島素治療與適度胰島素治療對重癥急性胰腺炎(SAP)患者預後的影響.方法 迴顧性分析2005年1月至2009年12月蘭州大學第二醫院普通外科收治的78例SAP閤併高血糖癥患者的臨床資料.根據治療方案,分為彊化組(31例)和適度組(47例),彊化組維持血糖在0.80～ 1.10 g/L(4.4 ～6.1 mmol/L),而適度組維持血糖在1.44～1.80 g/L(8.0 ～ 10.0 mmol/L),比較兩種血糖控製策略對患者預後的影響.計量資料採用t檢驗,計數資料採用x2檢驗.結果 兩組患者接受胰島素治療情況:(1)血糖控製:彊化組平均每日胰島素用量為(35 ±11)u,平均晨測空腹血糖為(1.02 ±0.13) g/L[ (5.7±0.7)mmol/L],10％(3/31)的患者髮生嚴重低血糖癥;適度組平均每日胰島素用量為(24±15)u,平均晨測空腹血糖為(1.58 ±0.21) g/L[ (8.8±1.2) mmol/L],2％ (1/47)的患者髮生嚴重低血糖癥.兩組患者平均每日胰島素用量比較,差異有統計學意義(t=12.76,P＜0.05);而兩組患者嚴重低血糖癥髮生率比較,差異無統計學意義(x2=0.91,P ＞0.05).(2)營養指標:彊化組和適度組患者入院第14天的Alb分彆為(34 ±6)g/L和(35 ±5) g/L,前白蛋白分彆為(231 ±31) mg/L和(241±29) mg/L,兩組比較,差異無統計學意義(t=-1.94,-1.68,P＞0.05).(3)臨床預後:彊化組和適度組患者腹腔感染、循環障礙、呼吸障礙、穫得性腎功能損害髮生率分彆為23％(7/31)、32％( 10/31)、26％(8/31)、13％(4/31)和26％(12/47)、36％(17/47)、30％( 14/47)、23％(11/47),入院第14天APPACHEⅡ評分分彆為(9±4)分和(9±3)分,兩組患者4種併髮癥髮生率和APPACHEⅡ評分比較,差異均無統計學意義(x2=0.09,0.13,0.15,1.33,t=-0.60,P＞0.05).彊化組和適度組分彆有13％(4/31)和15％(7/47)的患者因MODS死亡,其中彊化組2例、適度組6例閤併膿毒癥.兩組患者病死率比較,差異無統計學意義(x2=0,P＞0.05).結論 與適度胰島素治療比較,早期彊化胰島素治療併不能顯著改善SAP患者的預後,SAP高血糖癥患者實施適度胰島素治療是閤理可行的.
목적 비교조기강화이도소치료여괄도이도소치료대중증급성이선염(SAP)환자예후적영향.방법 회고성분석2005년1월지2009년12월란주대학제이의원보통외과수치적78례SAP합병고혈당증환자적림상자료.근거치료방안,분위강화조(31례)화괄도조(47례),강화조유지혈당재0.80～ 1.10 g/L(4.4 ～6.1 mmol/L),이괄도조유지혈당재1.44～1.80 g/L(8.0 ～ 10.0 mmol/L),비교량충혈당공제책략대환자예후적영향.계량자료채용t검험,계수자료채용x2검험.결과 량조환자접수이도소치료정황:(1)혈당공제:강화조평균매일이도소용량위(35 ±11)u,평균신측공복혈당위(1.02 ±0.13) g/L[ (5.7±0.7)mmol/L],10％(3/31)적환자발생엄중저혈당증;괄도조평균매일이도소용량위(24±15)u,평균신측공복혈당위(1.58 ±0.21) g/L[ (8.8±1.2) mmol/L],2％ (1/47)적환자발생엄중저혈당증.량조환자평균매일이도소용량비교,차이유통계학의의(t=12.76,P＜0.05);이량조환자엄중저혈당증발생솔비교,차이무통계학의의(x2=0.91,P ＞0.05).(2)영양지표:강화조화괄도조환자입원제14천적Alb분별위(34 ±6)g/L화(35 ±5) g/L,전백단백분별위(231 ±31) mg/L화(241±29) mg/L,량조비교,차이무통계학의의(t=-1.94,-1.68,P＞0.05).(3)림상예후:강화조화괄도조환자복강감염、순배장애、호흡장애、획득성신공능손해발생솔분별위23％(7/31)、32％( 10/31)、26％(8/31)、13％(4/31)화26％(12/47)、36％(17/47)、30％( 14/47)、23％(11/47),입원제14천APPACHEⅡ평분분별위(9±4)분화(9±3)분,량조환자4충병발증발생솔화APPACHEⅡ평분비교,차이균무통계학의의(x2=0.09,0.13,0.15,1.33,t=-0.60,P＞0.05).강화조화괄도조분별유13％(4/31)화15％(7/47)적환자인MODS사망,기중강화조2례、괄도조6례합병농독증.량조환자병사솔비교,차이무통계학의의(x2=0,P＞0.05).결론 여괄도이도소치료비교,조기강화이도소치료병불능현저개선SAP환자적예후,SAP고혈당증환자실시괄도이도소치료시합리가행적.
Objective To compare the efficacies of early intensive and moderate insulin therapy on the prognosis of patients with severe acute pancreatitis (SAP).Methods The clinical data of 78 patients with SAP complicated by hyperglycemia who were admitted to the Second Hospital of Lanzhou University from January 2005 to December 2009 were retrospectively analyzed.All patients were divided into the intensive insulin therapy (IIT)group (31 patients) and moderate insulin therapy (MIT) group (47 patients).The target levels of blood glucose were 0.80-1.10 g/L(4.4-6.1 mmol/L) in the IIT group and 1.44-1.80 g/L(8.0-10.0 mmol/L) in the MIT group,respectively.The effects of the 2 therapies on the prognosis of the patients were compared.All data were analyzed by the t test or chi-square test.Results The daily intravenous insulin dosage,fasting glucose level and incidence of severe hypoglycemia were ( 35 ± 11 ) u,( 1.02 ± 0.13 ) g/L[ (5.7 ± 0.7 ) mmol/L] and 10％ (3/31 )in the IIT group,and ( 24 ± 15 ) u,( 1.58 ± 0.21 ) g/L[ ( 8.8 ± 1.2 ) mmol/L] and 2％ ( 1/47 ) in the MIT group.A significant difference was detected in the daily intravenous insulin dosage between the 2 groups( t =12.76,P ＜=0.05),but no significant difference was detected in the incidence of severe hypoglycemia between the 2 groups (x2 =0.91,P ＞ 0.05 ).The levels of albumin and prealbumin on the 14th day were ( 34 ± 6) g/L and (231 ± 31 ) mg/L in the IIT group,and (35 ± 5)g/L and (241 ± 29)mg/L in the MIT group,respectively,with no significant difference between the 2 groups( t =-1.94,-1.68,P ＞ 0.05).The incidences of abdominal infection,circulatory dysfunction,respiratory dysfunction and acquired kidney injury were 23％ (7/31),32％ (10/31),26％ (8/31)and 13％ (4/31) in the lIT group,and 26％ (12/47),36％ ( 17/47),30％ (14/47) and 23％ (11/47) in the MIT group,with no significant difference between the 2 groups(x2 =0.09,0.13,0.15,1.33,P ＞ 0.05).The scores of APPACHE Ⅱ on the 14th day were 9 ± 4 in the IIT group and 9 ± 3 in the MIT group,respectively,with no significant difference between the 2 groups ( t =- 0.60,P ＞ 0.05 ).There were 4 ( 13％ ) patients in the IIT group and 7( 15％ ) patients in the MIT group died of multi-organ dysfunction syndrome,including 2 patients in the IIT group and 6 patients in the MIT group complicated with sepsis.There was no significant difference in the mortality between the 2 groups ( x2 =0,P ＞ 0.05 ).Conclusions Compared with MIT,early IIT could not improve the prognosis of the patients with SAP.MIT is appropriate for SAP patients complicated with hyperglycemia.
