术中胰岛素输注方案与胰岛素丸方案对冠脉搭桥手术期间血糖管理:一项随机临床试验

Q3 Pharmacology, Toxicology and Pharmaceutics
Rami Alqassieh, Mohanad Odeh, Feras Jirjees
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引用次数: 0

摘要

背景与目的:手术引起的应激会破坏肝脏葡萄糖生成和体内葡萄糖利用之间的微妙平衡。尽管术中血糖控制对糖尿病患者具有重要意义,但这方面的关注有限。有两种方法可以在手术中使用胰岛素来控制血糖水平。本研究旨在比较接受冠状动脉旁路移植术(CABG)的糖尿病患者使用胰岛素输注和大剂量方法的术中血糖水平。方法:采用随机临床试验(RCT)。70名40岁及以上的糖尿病患者参加了CABG手术。他们被随机分配,采用块随机法,通过输注或丸法接受术中胰岛素。主要结局指标为术中血糖水平。随后的胰岛素单位需求和术中钾水平是次要结果。在整个CABG过程中监测数据,并在六个不同的检查点记录数据。结果:两组患者均以男性为主,患者术前HbA1c水平及合并症等特征无显著差异。与注射方案相比,输注方案显示具有统计学意义的血糖水平降低(-19.12 mg/dL, 95% CI: -27.68至-10.55,P<0.001, Cohen’s d=1.06)。输注组总胰岛素单位为480单位,而大剂量组为600单位(P=0.001, Cohen’s d=0.85)。重要的是,患者中没有低血糖或高钾血症的病例报告。结论:术中胰岛素控制血糖对合并糖尿病的CABG患者有效。然而,与大剂量方案相比,输液方案在统计学上表现出优越的结果。临床试验注册和注册号:该试验于2019年2月1日获得伦理委员会批准,并在Clinicaltrials.gov上注册,ID: NCT04824586。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Intraoperative Insulin Infusion Regimen versus Insulin Bolus Regimen for Glucose Management during CABG Surgery: A Randomized Clinical Trial
Background and Aim: The stress induced by surgery disrupts the delicate balance between hepatic glucose production and glucose utilization in the body. Despite the significance of intraoperative glycaemic control for diabetic patients, limited attention has been given to this aspect. Two methods for administering insulin to manage glucose levels during surgery exist. This study aimed to compare intraoperative glucose levels in diabetic patients undergoing Coronary Artery Bypass Graft (CABG) surgery using either insulin infusion or the bolus method. Method: This was a Randomized Clinical Trial (RCT). Seventy diabetic patients aged 40 or older scheduled for CABG surgery were enrolled in the trial. They were randomly assigned, using block randomization, to receive intraoperative insulin via either infusion or the bolus method. The primary outcome measure was intraoperative glucose levels. Subsequent insulin unit requirements and intraoperative potassium levels were secondary outcomes. Data was monitored throughout the CABG procedure and recorded at six different checkpoints. Results: Male patients constituted the majority in both groups, with no significant differences in the preoperative characteristics of patients, including HbA1c levels and comorbidities. The infusion regimen demonstrated a statistically significant reduction in glucose levels (-19.12 mg/dL, 95% CI: -27.68 to -10.55, P<0.001, Cohen's d=1.06) compared to the bolus regimen. The total insulin units administered in the infusion group were 480 units, as opposed to 600 units in the bolus group (P=0.001, Cohen's d=0.85). Importantly, no cases of hypoglycemia or hyperkalemia were reported among the patients. Conclusion: Intraoperative glucose control using insulin was effective for CABG patients with diabetes. However, the infusion regimen exhibited statistically superior results compared to the bolus regimen. Clinical Trials Registry and Registration Number: The trial received approval from the Ethics Committee on 2/1/2019/2020 and was registered on Clinicaltrials.gov under ID: NCT04824586.
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来源期刊
Jordan Journal of Pharmaceutical Sciences
Jordan Journal of Pharmaceutical Sciences Pharmacology, Toxicology and Pharmaceutics-Pharmaceutical Science
CiteScore
1.70
自引率
0.00%
发文量
33
期刊介绍: The Jordan Journal of Pharmaceutical Sciences (JJPS) is a scientific, bi-annual, peer-reviewed publication that will focus on current topics of interest to the pharmaceutical community at large. Although the JJPS is intended to be of interest to pharmaceutical scientists, other healthy workers, and manufacturing processors will also find it most interesting and informative. Papers will cover basic pharmaceutical and applied research, scientific commentaries, as well as views, reviews. Topics on products will include manufacturing process, quality control, pharmaceutical engineering, pharmaceutical technology, and philosophies on all aspects of pharmaceutical sciences. The editorial advisory board would like to place an emphasis on new and innovative methods, technologies, and techniques for the pharmaceutical industry. The reader will find a broad range of important topics in this first issue.
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