胰岛素强化治疗对胃癌手术患者临床结局的影响

摘要

目的 研究胰岛素强化治疗对胃癌手术患者临床结局的影响.方法 46例胃癌手术患者随机分为术后胰岛素强化治疗组(n=23,血糖控制在4.4～6.1 mmool/L)和常规治疗组(n=23,血糖控制在10.0～11.1 mmol/L).动态监测比较两组围手术期空腹血糖(FBG)、空腹胰岛素定量(FINS)、白细胞介素-6(IL-6)、肿瘤坏死因子-α[(TNF-α)及C-反应蛋白(CRP)水平,并根据稳态模式评估法(HOMA)计算胰岛素抵抗指数(HOMA-IR);记录两组患者术后并发症发生情况.结果 两组患者均无低血糖发生,胰岛素强化治疗组术后发热天数、抗生素使用天数、住院天数及并发症发生率均明显低于常规治疗组(P＜0.05);强化治疗组术后1 d、3 d血清InHOMA-IR、IL-6、TNF-α及术后1、3、7 d的CRP均明显低于常规治疗组(P＜0.05).结论 胰岛素强化治疗可拮抗术后机体的高炎状态,抗炎效应可能是胰岛素强化治疗又一改善手术创伤患者预后的重要机制.%Objective To investigate the influence of intensive insulin therapy on the results of postoperative patients with gastric cancer.Methods Forty-six patients with gastric cancer underwent radical operation were randomly divided into two groups:intensive group(n=23,to control blood glucose at 4.4 to 6.1 mmol/L)and conventional group(n=23,to control blood glucose at 10.0 to 11.1 mmol/L).Fasting blood glucose(FBG),fasting insulin(FINS),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6) and C reaction protein(CRP)in 46 patients were detected dynamically during perioperative period.Insulin resistance index(HOMA-IR)were calculated using Hemeostasis Model Assessment(HOMA)to evaluate insulin sensitivity.Postoperative complications and other clinical data were recorded.Results No hypoglycemia occurred in the two groups.Compared with conventional group,morbidity and postoperative duration of fever,antibiotic use and the length of hospital stay in intensive group were significantly reduced (P＜0.05).On the day 1 and 3 after surgery,HOMA-IR and serum levels of TNF-α,IL-6 and CRP in patients of intensive group were significantly lower than those in conventional group(P＜0.05).Conclusions Intensive insulin therapy could counteract the state of high-inflammation and then improve the outcome of postoperative patients.