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目的:探讨甘精胰岛素用于II型糖尿病患者手术后血糖控制的可行性。方法:选择51例接受外科手术后的II型糖尿病患者,分为甘精胰岛素治疗组(LAN组)16例,常规生物合成人胰岛素治疗组(MSII组)19例,胰岛素泵治疗组(CSII组)16例。LAN组患者术后使用甘精胰岛素,视空腹血糖变化情况调整其剂量,患者如进食则于餐前给予短效胰岛素。MSII组术后用静脉胰岛素输注,患者进食后可逐渐采用传统胰岛素强化治疗方案(R+R+R+NPH)。CSII组每天24 h持续泵入短效胰岛素,禁食期只给予基础量,进食后给予基础和餐时量。观察各组患者治疗前后血糖变化、胰岛素用量、低血糖发生率及术后并发症发生率,酮症发生率。结果:各组治疗后血糖均明显低于治疗前,LAN组治疗后血糖低于MSII组,与CSII组无明显差异;LAN组低血糖发生率低于MSII组,而与CSII比较无显著性差异。结论:II型糖尿病患者术后禁食或进食不规律阶段,使用常规胰岛素治疗,血糖波动较大且患者依从性差;甘精胰岛素在糖尿病患者手术后降糖效果显著,能迅速、平稳控制血糖且患者依从性好,是一种安全、有效且患者易接受的用于II型糖尿病患者术后治疗的药物。
Objective: To investigate the feasibility of using insulin glargine for blood glucose control in type 2 diabetic patients after surgery. Methods: Totally 51 patients with type 2 diabetes mellitus undergoing surgery were enrolled in this study. They were divided into insulin glargine group (LAN group), routine insulin biosynthesis group (MSII group), insulin pump group (CSII group) ) 16 cases. Patients in LAN group were treated with insulin glargine after surgery and adjusted their dosage according to the change of fasting blood glucose. Patients were given short-acting insulin before meals. MSII group after intravenous infusion of insulin, the patient can gradually adopt the traditional insulin therapy (R + R + R + NPH). CSII group continued to pump short-acting insulin 24 hours a day, fasting only give the basic amount, after eating given basic and meal volume. The changes of blood glucose, insulin dosage, the incidence of hypoglycemia, the incidence of postoperative complications and the incidence of ketosis were observed before and after treatment in each group. Results: After the treatment, the blood glucose in each group was significantly lower than that before treatment. The blood glucose of the patients in the LAN group was lower than that in the MSII group and no significant difference with the CSII group. The incidence of hypoglycemia in the LAN group was lower than that in the MSII group, but no significant difference . Conclusion: Patients with type II diabetes after fasting or eating irregular phase, the use of conventional insulin therapy, blood glucose fluctuations and poor compliance of patients; glargine in patients with diabetes after hypoglycemic effect was significant, rapid and stable control of blood glucose and Patient compliance is a safe, effective, and patient-acceptable drug for post-operative treatment of type 2 diabetes.