Namikawa Tsutomu, Munekage Masaya, Yatabe Tomoaki, Kitagawa Hiroyuki, Hanazaki Kazuhiro
Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan.
Department of Anesthesiology, Kochi Medical School, Nankoku, Kochi, Japan.
J Artif Organs. 2018 Jun;21(2):132-137. doi: 10.1007/s10047-018-1019-4. Epub 2018 Jan 22.
Surgical stress induces hyperglycemia and gives rise to glucose toxicity, which causes infectious diseases, resulting in unfavorable surgical outcomes. Intensive insulin treatment can control short- and long-term complications in patients with not only diabetes mellitus, but also surgical diabetes; however, it is associated with an increased risk of hypoglycemia. The wearable artificial pancreas was originally developed to control glucose levels in patients with type 1 diabetes, progressing to a device with enhanced stability and safety for these patients. Its usability has further progressed to include patients with type 2 diabetes. The bedside artificial pancreas is the only closed-loop-type artificial pancreas which can maintain stable glycemic control in accordance with a target blood glucose range, based on the patient's actual blood glucose levels. Moreover, this stable glycemic control with a low variation in blood glucose concentration within the target range is produced without any hypoglycemia. Significant advances of this device will now occur due to the approval of treatment for perioperative glycemic control by the Japanese Health Care Insurance System in 2016. Along with an increase in the number of mainly elderly patients with low glucose tolerance, it is expected that the role of the artificial pancreas will increase in the future. Considering the current state and expense of regenerative and transplant medicine, along with donor shortages, further development of the artificial pancreas and associated glycemic control can be expected.
手术应激会导致高血糖并引发葡萄糖毒性,进而引发感染性疾病,导致手术预后不佳。强化胰岛素治疗不仅可以控制糖尿病患者的短期和长期并发症,还能控制手术性糖尿病患者的并发症;然而,它会增加低血糖风险。可穿戴人工胰腺最初是为控制1型糖尿病患者的血糖水平而开发的,后来发展成为一种对这些患者具有更高稳定性和安全性的设备。其适用性进一步扩大到2型糖尿病患者。床边人工胰腺是唯一一种闭环式人工胰腺,它可以根据患者的实际血糖水平,按照目标血糖范围维持稳定的血糖控制。此外,这种在目标范围内血糖浓度变化较小的稳定血糖控制是在无低血糖的情况下实现的。由于2016年日本医疗保健保险系统批准了围手术期血糖控制治疗,该设备将取得重大进展。随着主要是葡萄糖耐量低的老年患者数量的增加,预计人工胰腺在未来的作用将增强。考虑到再生医学和移植医学的现状及费用,以及供体短缺的问题,人工胰腺及其相关血糖控制有望得到进一步发展。