Okabayashi Takehiro, Hnazaki Kazuhiro, Nishimori Isao, Sugimoto Takeki, Maeda Hiromichi, Yatabe Tomoaki, Dabanaka Ken, Kobayashi Michiya, Yamashita Koichi
Department of Surgery, Kochi Medical School, Kohasu-Okocho, Nankoku City, Kochi, Japan.
Dig Dis Sci. 2008 May;53(5):1405-10. doi: 10.1007/s10620-007-0010-3. Epub 2007 Oct 13.
Hyperglycemia induced by surgical stress often causes the dysregulation of liver metabolism and immune function resulting in impaired post-operative recovery. The aim of this study was to evaluate the usefulness of a closed-loop system providing continuous monitoring and strict control of post-operative blood glucose in patients after hepatic resection.
A total of 19 patients who underwent hepatic resection for primary liver tumor between August and December 2006 were enrolled in the study. Following surgery, blood glucose was continuously monitored by the STG-22 closed-loop system. Glucose levels were controlled using either a manual injection of insulin according to the commonly used sliding scale (manual insulin group, n = 9) or a programmed infusion of insulin determined by the control algorithm of the STG-22 (programmed insulin group, n = 10). The total amount of insulin used in the first 16 h following hepatic resection in the two groups was measured.
In the manual insulin group, post-operative blood glucose rose initially and reached a plateau of approximately 250 mg/dl between 4 h and 7 h post-hepatectomy and then returned towards normal levels by 16 h. In the programmed insulin group, blood glucose was steadily lowered, reaching the target zone (90-110 mg/dl) by 12 h post-surgery. The total amount of insulin administered per patient during the first 16 h post-surgery was significantly higher in the programmed insulin group (183 +/- 188 IU) than in the manual insulin group (8 +/- 7 IU; P < 0.001). No hypoglycemia was observed in either group.
Post-operative hyperglycemia was observed for up to 16 h in hepatectomized patients. In this post-operative hyperglycemic state, the STG-22 closed-loop system safely and quickly achieved glycemic control, indicating its clinical value in the post-operative management of hepatectomized patients.
手术应激诱导的高血糖常导致肝脏代谢和免疫功能失调，进而致使术后恢复受损。本研究旨在评估一种闭环系统对肝切除术后患者进行术后血糖连续监测及严格控制的有效性。
选取2006年8月至12月间因原发性肝肿瘤接受肝切除术的19例患者纳入本研究。术后，采用STG - 22闭环系统持续监测血糖。根据常用的滑动标尺通过手动注射胰岛素来控制血糖水平（手动胰岛素组，n = 9），或依据STG - 22的控制算法进行胰岛素程序化输注来控制血糖水平（程序化胰岛素组，n = 10）。测定两组患者肝切除术后前16小时内使用的胰岛素总量。
手动胰岛素组术后血糖最初升高，在肝切除术后4至7小时达到约250 mg/dl的平台期，随后在16小时时恢复至正常水平。在程序化胰岛素组中，血糖稳步下降，术后12小时达到目标范围（90 - 110 mg/dl）。程序化胰岛素组患者术后前16小时内每位患者的胰岛素总给药量（183 ± 188 IU）显著高于手动胰岛素组（8 ± 7 IU；P < 0.001）。两组均未观察到低血糖情况。
肝切除患者术后高血糖可持续长达16小时。在这种术后高血糖状态下，STG - 22闭环系统安全且快速地实现了血糖控制，表明其在肝切除术后患者管理中的临床价值。
