胃癌合并糖尿病患者术后强化血糖控制的疗效分析

目的：探讨胃癌合并糖尿病患者术后强化血糖控制的临床疗效及其对预后的影响。方法：根据不同血糖控制方法,将96例胃癌合并糖尿病术后患者分为强化血糖控制组50例（血糖控制在4.4-6.1mol/L）和对照组46例（血糖控制在6.1~11.1mol/L）。监测患者术后1、3、7天的空腹血糖（FBG）、空腹胰岛素定量（FINS）、及C反应蛋白（CRP）水平,并计算胰岛素抵抗指数（HOMA-IR）,比较分析两组术后恢复情况及并发症发生情况。结果：术后1、3、7天,强化血糖控制组FBG、lnHOMA-IR及CRP水平均显著低于对照组,差异有统计学意义（P〈0.05）;术后1天两组间FINS水平差异无统计学意义（P〉0.05）,而术后3、7天,二者之间差异有统计学意义（P〈0.05）;强化血糖控制组术后发热时间、排气时间、抗生素使用时间与对照组相比明显缩短,差异有统计学意义（P〉0.05）;强化血糖控制组术后并发症的发生率2.0%,显著低于对照组13.0%,差异有统计学意义（P〈0.05）。结论：强化血糖控制可改善胃癌合并糖尿病患者术后胰岛素抵抗,减轻术后的炎性反应,降低术后并发症,改善患者预后。

The Effect of intensive Glycemic Control on Postoperative Gastric Cancer Patients Combined with Diabetes

Objective： To explore clinical effect of intensive glycemic control on postoperative gastric cancer patients combined with diabetes and its influence on prognosis.Methods： According to the method of glycemic control,96 cases of postoperative gastric cancer patients combined with diabetes were divided into two groups,including 50 cases of intensive glycemic control group（to control blood glucose at 4.4~6.1mol/L）,46 cases of control group（to control blood glucose at 6.1~11.1mol/L）.Fasting blood glucose（FBG）,fasting insulin（FINS） and C reaction protein（CRP） in all patients were detected at 1st,3rd and 7th day after operation,and the insulin re-sistance index（HOMA-IR） were calculated.Postoperative complications and other clinical data were compared and analyzed.Results： FBG,lnHOMA-IR and CRP in intensive glycemic control group were significantly lower than those in control group at 1st,3rd and 7th day after operation（P0.05）.There are no significant difference on FINS among the two groups at 1st day after operation（P0.05）,while the difference is significant at 3rd and 7th day after operation（P0.05）.Compared with control group,postoperative duration of fever,antibiotic use and time of anal exhaust in intensive glycemic control group were significantly reduced（P0.05）.The rate of postoperative complica-tions in intensive glycemic control group（2.0%） was significantly higher that in control group（13.0%）.Conclusions： Intensive glycemic control can contribute to improve insulin resistance,reduce inflammation reaction and postoperative complications,and improve the prognosis of postoperative gastric cancer patients combined with diabetes.