【罂粟摘要】持续皮下输注胰岛素可降低术后感染风险
持续皮下输注胰岛素可降低术后感染风险
贵州医科大学 高鸿教授课题组
翻译：安丽 编辑：佟睿 审校：曹莹
术后感染与围手术期高血糖有关，正确处理围手术期的血糖管理已成为改善患者预后的关键。
对我院1015例需手术的患者中，因高血糖行胰岛素治疗的糖尿病患者进行回顾性分析。根据倾向匹配，我们从接受持续皮下注射胰岛素（CSII）治疗组（CSII组）和接受胰岛素注射治疗组（非CSII组）中获得253对患者。比较两组围手术期血糖水平和相应的预后。
与非CSII组相比，CSII组空腹和平均血糖水平较低，发热发生率较低（手术日：18.6%vs10.2%；P=.014；术后第一天：55.1%vs34.7%；术后分泌物培养阳性率（6.3%vs1.2%；P=0.004），抗生素使用时间更短（抗生素总使用量：P=0.002；术后抗生素使用：P<0.001）和住院时间（P<0.001）。然而，两组之间的总医疗费用没有差异（P=0.499）。进一步分析表明，CSII组和MDI组的64对患者进行比较后发现，CSII治疗在感染和其他术后结果方面优于每日多次胰岛素注射MDI治疗。
CSII治疗能更好地控制围手术期血糖，降低术后感染的风险，而不增加总医疗费用。
Yune Mou, Delin Ma, Jianhua Zhang, et al. Continuous subcutaneous insulin infusion reduces the risk of postoperative infection.[J]Journal of Diabetes, 2020 12:396-405.
Continuous subcutaneous insulin infusion reduces the risk of postoperative infection
Abstract
Background: Perioperative hyperglycemia was associated with postoperative infection,and proper management of perioperative glucose has become critical in improving the prognosis of patients.
Methods: A total of 1015 diabetic patients who underwent surgery and received insulin treatment for their hyperglycemia in our hospita lwere retrospectively reviewed. According to propensity matching, we obtained 253 pairs of patients from the group which received continuous subcutaneous in sulininfusion(CSII) therapy (CSIIgroup) and the group which received insulin injection therapy (non-CSII group). Perioperative glucose levels and corresponding outcomes were compared between the two groups.
Results: Compared with the non-CSII group, the CSII group had lower fasting and mean glucose levels, lower incidence of fever (operationday: 18.6%vs10.2%; P=.014; first postoperative day: 55.1%vs34.7%;P<.001), a positive rate of postoperative secretion culture (6.3%vs1.2%;P=.004), and a shorter time of antibioticsuse (total antibiotics use:P=.002; postoperative antibiotics use:P<.001) and hospital stays(P<.001). However, there was no difference in the total medica lexpenditure between the two groups(P=.499). Further analysis showed that CSII therapy was superior to multiple daily insulin injection(MDI) therapy in its effect on infection and other postoperative outcomes when 64 pairs of patients from the CSII groupand MDI group were compared.
Conclusions: CSII therapy provides better perioperative glucose control and a lower risk of postoperative infection without increasing the total medical expenditure.