静脉胰岛素泵联合持续血糖监测系统对肝移植术后患者血糖控制的有效性及安全性：附 1 例报道_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

陈淘江 , 陆玫竹 , 张中伟 ,  康焰

四川大学华西医院重症医学科（成都 610041）;

Corresponding author：

康焰, Email: kangyan@vip.sina.com

Keywords：

肝移植; 胰岛素泵; 持续血糖监测系统; 血糖控制; 效果

DOI：

10.7507/1007-9424.201702034

Video：

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目的总结 1 例肝移植患者术后使用胰岛素泵联合持续血糖监测系统（CGMS）进行血糖控制的有效性及安全性。方法回顾性分析笔者所在医院科室于 2015 年 11 月收治的 1 例肝移植患者的临床资料，该患者术后使用胰岛素泵联合 CGMS 进行血糖控制。结果本例患者的血糖控制时间为 4 127 min。血糖控制参数：最大值 9.8 mmol/L，最小值 4.7 mmol/L（自觉无头晕、乏力等低血糖症状），平均 6.9 mmol/L，目标血糖达标时间为4 030 min，占 98%。血糖变异参数：标准差（SD ）为 1.1 mmol/L，血糖不稳定指数为 7.32（mmol/L）²/（h·d），平均血糖波动幅度为 0，平均日内血糖改变为 3.4 mmol/L。控制期间营养情况：肠内营养的碳水化合物用量为 115 g，全胃肠外营养的碳水化合物用量为 516 g，胰岛素用量为 139 U（用量均值为 2 U/h），平均采样时间为 109 min。肝移植术后 3 周患者痊愈出院，术后 1 个月随访无不适，复查糖化血红蛋白为 4.9%。结论胰岛素泵联合 CGMS 的血糖控制效果较好，但该结论仍需要大样本、多中心及前瞻性的随机对照试验给予证实。

Citation： 陈淘江, 陆玫竹, 张中伟, 康焰. 静脉胰岛素泵联合持续血糖监测系统对肝移植术后患者血糖控制的有效性及安全性：附 1 例报道. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(10): 1254-1257. doi: 10.7507/1007-9424.201702034 Copy

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12.	NICE-SUGAR Study Investigators; Finfer S, Chittock DR, et al. Intensive versus conventional glucose control in critically ill patients. N Engl J Med, 2009, 360(13): 1283-1297.
13.	Omar AS, Salama A, Allam M, et al. Association of time in blood glucose range with outcomes following cardiac surgery. BMC Anesthesiol, 2015, 15: 14.
14.	Eslami S, Taherzadeh Z, Schultz MJ, et al. Glucose variability measures and their effect on mortality: a systematic review. Intensive Care Med, 2011, 37(4): 583-593.
15.	Leelarathna L, English SW, Thabit H, et al. Feasibility of fully automated closed-loop glucose control using continuous subcutaneous glucose measurements in critical illness: a randomized controlled trial. Crit Care, 2013, 17(4): R159.

1. Pfortmueller CA, Wiemann C, Funk GC, et al. Hypoglycemia is associated with increased mortality in patients with acute decompensated liver cirrhosis. J Crit Care, 2014, 29(2): 316.e7-316.e12.
2. Shangraw RE. Metabolic issues in liver transplantation. Int Anesthesiol Clin, 2006, 44(3): 1-20.
3. Ahmadieh H, Azar ST. Liver disease and diabetes: association, pathophysiology, and management. Diabetes Res Clin Pract, 2014, 104(1): 53-62.
4. 喻明, 周健, 项坤三, 等. 动态监测糖耐量正常者血糖水平的漂移变化. 中华医学杂志, 2004, 84(21): 1788-1790.0.
5. Blaha J, Barteczko-Grajek B, Berezowicz P, et al. Space Glucose Control system for blood glucose control in intensive care patients—a European multicentre observational study. BMC Anesthesiol, 2016, 16: 8..
6. Amrein K, Kachel N, Fries H, et al. Glucose control in intensive care: usability, efficacy and safety of Space Glucose Control in two medical European intensive care units. BMC Endocr Disord, 2014, 14: 62.
7. Eslami S, Taherzadeh Z, Schultz MJ, et al. Glucose variability measures and their effect on mortality: a systematic review. Intensive Care Med, 2011, 37(4): 583-593.
8. Krinsley JS. Glycemic variability in critical illness and the end of Chapter 1. Crit Care Med, 2010, 38(4): 1206-1208.
9. Krinsley JS. Glycemic control, diabetic status, and mortality in a heterogeneous population of critically ill patients before and during the era of intensive glycemic management: six and one-half years experience at a university-affiliated community hospital. Semin Thorac Cardiovasc Surg, 2006, 18(4): 317-325.
10. Hovorka R, Chassin LJ, Wilinska ME, et al. Closing the loop: the adicol experience. Diabetes Technol Ther, 2004, 6(3): 307-318.
11. van den Berghe G, Wouters P, Weekers F, et al. Intensive insulin therapy in critically ill patients. N Engl J Med, 2001, 345(19): 1359-1367.
12. NICE-SUGAR Study Investigators; Finfer S, Chittock DR, et al. Intensive versus conventional glucose control in critically ill patients. N Engl J Med, 2009, 360(13): 1283-1297.
13. Omar AS, Salama A, Allam M, et al. Association of time in blood glucose range with outcomes following cardiac surgery. BMC Anesthesiol, 2015, 15: 14.
14. Eslami S, Taherzadeh Z, Schultz MJ, et al. Glucose variability measures and their effect on mortality: a systematic review. Intensive Care Med, 2011, 37(4): 583-593.
15. Leelarathna L, English SW, Thabit H, et al. Feasibility of fully automated closed-loop glucose control using continuous subcutaneous glucose measurements in critical illness: a randomized controlled trial. Crit Care, 2013, 17(4): R159.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

静脉胰岛素泵联合持续血糖监测系统对肝移植术后患者血糖控制的有效性及安全性：附 1 例报道

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