Andersen Sakshi, Andersen Andreas, Ringholm Lene, Hansen Carsten Palnæs, Storkholm Jan, Lillpers Kerstin, Schiøtz Charlotte, Mathiesen Elisabeth Reinhardt
Dan Med J. 2018 Apr;65(4).
Pancreatogenic diabetes develops in patients undergoing total pancreatectomy and complicates post-surgical management. The aim of this study was to compare parenteral nutrition (PN) with protocolled insulin treatment to intravenous glucose treatment after total pancreatectomy.
This was a retrospective study of 97 patients undergoing total pancreatectomy between 2009 and 2014. Patients were divided into a PN cohort (n = 57) and a glucose cohort (n = 40). The PN cohort was given PN with one international unit (IU) rapid-acting insulin per 10 g of carbohydrate. The glucose cohort was given a continuous 5% glucose infusion with 2 IU rapid-acting insulin per 10 g of carbohydrate. Both cohorts were given insulin detemir 0.2 IU/kg/day.
Within the first 13 post-operative days, plasma glucose values were within the target range (4.0-10.0 mmol/l) in the PN cohort more frequently than in the glucose cohort (46% versus 42%, p = 0.01) without any increase in hypoglycaemia. Non-infectious complications occurred less frequently in the parenteral cohort than in the glucose cohort (23% versus 43%, p = 0.04). Infectious complications occurred in 19% versus 33% of patients, respectively (p = 0.14). The mean length of hospitalisation was 19.8 ± 12.7 versus 25.0 ± 21.5 days, p = 0.14.
After total pancreatectomy, PN with insulin treatment per protocol improves glycaemic control compared with glucose infusion and reduces the number of non-infectious post-operative complications without increasing hypoglycaemia.
none.
not relevant.
胰腺源性糖尿病在接受全胰切除术的患者中出现，并使术后管理复杂化。本研究的目的是比较全胰切除术后肠外营养（PN）联合胰岛素规范治疗与静脉葡萄糖治疗的效果。
这是一项对2009年至2014年间97例接受全胰切除术患者的回顾性研究。患者被分为PN组（n = 57）和葡萄糖组（n = 40）。PN组每10克碳水化合物给予1国际单位（IU）速效胰岛素的PN治疗。葡萄糖组给予持续的5%葡萄糖输注，每10克碳水化合物给予2 IU速效胰岛素。两组均给予地特胰岛素0.2 IU/kg/天。
在术后的前13天内，PN组血浆葡萄糖值在目标范围（4.0 - 10.0 mmol/L）内的频率高于葡萄糖组（46%对42%，p = 0.01），且低血糖无增加。肠外营养组非感染性并发症的发生率低于葡萄糖组（23%对43%，p = 0.04）。感染性并发症分别发生在19%和33%的患者中（p = 0.14）。平均住院时间为19.8 ± 12.7天对25.0 ± 21.5天，p = 0.14。
全胰切除术后，与葡萄糖输注相比，按照方案进行胰岛素治疗的PN可改善血糖控制，并减少术后非感染性并发症的数量，且不增加低血糖发生率。
无。
不相关。
