摘要
目的观察自拟养阴活血益胃汤联合胰岛素强化治疗对非糖尿病胃癌根治术后应激性高血糖患者糖代谢、应激状态、能量代谢的影响。方法将82例非糖尿病胃癌根治术后应激性高血糖患者随机分为观察组(40例)和对照组(42例),2组术后均接受常规治疗,对照组在常规治疗基础上给予胰岛素强化治疗,观察组在对照组治疗基础上给予自拟养阴益胃汤治疗,疗程7 d。观察2组治疗前及治疗3 d、5 d、7 d后糖代谢、应激状态、能量代谢情况,并记录2组临床结局。结果 2组治疗3 d、5 d、7 d后空腹血糖、血清胰岛素、胰岛素抵抗指数(HOMA-IR)和血清CRP、WBC、IL-6、TNF-α水平均逐渐降低(P均<0.05),胰岛素分泌指数(HOMA-β)逐渐升高(P均<0.05),且观察组以上指标改善情况均显著优于对照组(P均<0.05);观察组治疗3 d、5 d、7 d空腹血糖恢复率和血清前白蛋白(PA)、白蛋白(ALB)水平均显著高于对照组(P均<0.05),呼吸商(RQ)和静态能量消耗(REE)均显著低于对照组(P均<0.05);观察组胃肠道功能恢复情况、一般临床结局均显著优于对照组(P均<0.05)。结论自拟养阴活血益胃汤联合胰岛素强化治疗能够显著改善非糖尿病胃癌根治术后胰岛β细胞功能,促进血糖恢复,并抑制应激反应,改善能量代谢、营养状态及临床结局,减少并发症。
Objective It is to observe the effects of Yangyin Huoxue Yiwei Decoction( YHYD) combined with intensive insulin therapy on glucose metabolism,stress state and energy metabolism in patients with stress hyperglycemia after radical gastrectomy for non-diabetic gastric cancer. Methods 82 patients with stress hyperglycemia after radical gastrectomy for non-diabetic gastric cancer were randomly divided into observation group( 40 cases) and control group( 42 cases). All the patients of the two groups were treated with routine treatment after operation. On the basis of routine treatment,the patients in control group were given intensive insulin therapy,and the patients in observation group were treated with YHYD plus intensive insulin therapy. The course of treatment was 7 days. The glucose metabolism,stress state and energy metabolism were observed before and after 3-,5-and 7-day of treatment in the two groups. The clinical outcomes were recorded in the two groups. Results After 3-,5-and 7-day of treatment,the fasting blood glucose,serum insulin,insulin resistance index( HOMA-IR) and serum CRP,WBC,IL-6 and TNF-α levels in the two groups were decreased gradually( all P <0. 05) and the insulin secretion index( HOMA-β) were increased gradually( all P < 0. 05),the improvement of the above indexes in the observation group was significantly better than that of the control group( P < 0. 05). The recovery rate of abdominal blood glucose of treated for 3-,5-and 7-day and the level of serum prealbumin( PA) and albumin( ALB) in the observation group were significantly higher than those in the control group( all P < 0. 05). The respiratory quotient( RQ)and static energy consumption( REE) of the observation group were significantly lower than those of the control group( all P < 0. 05). The recovery of gastrointestinal function and general clinical outcome of the observation group were significantly better than those of the control group( all P < 0. 05). Conclusion YHYD combined with intensive insulin therapy can significantly improve the function of pancreatic islet beta cells after radical gastrectomy for non-diabetic gastric cancer,promote blood sugar recovery,it also inhibits stress response,improves energy metabolism,nutritional status and clinical outcomes,and reduces complications.
出处
《现代中西医结合杂志》
CAS
2018年第9期913-917,共5页
Modern Journal of Integrated Traditional Chinese and Western Medicine
基金
上海市自然科学基金项目(15ZR1441800)
关键词
养阴活血益胃汤
胰岛素强化治疗
胃癌根治术
应激性高血糖
应激反应
预后
Yangyin Huoxue Yiwei Decoction
intensive insulin therapy
radical gastrectomy
stress hyperglycemia
stress response
prognosis
作者简介
叶圳,男,硕士,研究方向为中西医结合防治胃肠肝胆胰疾病;[通信作者]顾宏刚,E-mail：honggaggu@126.com
