A case of perioperative glucose control by using an artificial pancreas in a patient with glycogen storage disease
A case of perioperative glucose control by using an artificial pancreas in a patient with glycogen storage disease
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DOI：
10.1007/s10047-015-0855-8
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发表时间：
2016-03-01
影响因子：
1.3
通讯作者：
Hanazaki, Kazuhiro
中科院分区：
文献类型：
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作者：
Yatabe, Tomoaki;Nakamura, Ryu;Hanazaki, Kazuhiro
一名57岁的妇女在二十多岁时被诊断为I型糖原累积病。她在全身麻醉和硬膜外麻醉下接受了肝切除术。麻醉诱导后50分钟，将20号静脉导管插入患者的右手，并将人工胰腺（STG-55，Nikkiso Co.，东京，日本）进行连续血糖监测和自动血糖控制。当血糖水平达到120 mg/dL或更高时输注胰岛素，当水平降至100 mg/dL或更低时输注葡萄糖。在Pringle操作后，血糖水平升高，并通过人工胰腺自动给予胰岛素。术中未发生低血压。在重症监护室（ICU）开始全肠外营养后，血糖水平升高，人工胰腺通过自动胰岛素给药控制血糖水平。在进入ICU 34小时后，由于采血失败，人工胰腺被移除。取出人工胰腺后，每2小时测量一次血糖水平，直至拔管。在ICU住院期间，未发生低血糖，平均血糖水平为144 mg/dL。总之，在糖原累积病患者中使用人工胰腺进行围手术期血糖管理具有能够在不发生低血糖的情况下管理血糖水平的有益效果。
A 57-year-old woman was diagnosed with type I glycogen storage disease in her twenties. She had undergone hepatectomy under general anesthesia with epidural anesthesia. Fifty minutes after the induction of anesthesia, a 20-gauge venous catheter was inserted in the patient's right hand, and an artificial pancreas (STG-55, Nikkiso Co., Tokyo, Japan) was connected for continuous glucose monitoring and automatic glucose control. Insulin was infused when the blood glucose level reached 120 mg/dL or higher, and glucose was infused when the level fell to 100 mg/dL or lower. After the Pringle maneuver, the blood glucose level increased, and insulin was administered automatically via an artificial pancreas. Hypoglycemia did not occur during the operation. After total parenteral nutrition was started in the intensive care unit (ICU), the blood glucose level increased, and the artificial pancreas controlled the blood glucose level through automatic insulin administration. Thirty-four hours after admission to the ICU, the artificial pancreas was removed because the blood sampling failed. After the removal of the artificial pancreas, blood glucose level was measured every 2 h until extubation. During the ICU stay, hypoglycemia never occurred, with the average blood glucose level being 144 mg/dL. In conclusion, the use of an artificial pancreas for perioperative blood glucose management in a patient with glycogen storage disease had the beneficial effect of enabling the management of blood glucose levels without hypoglycemia.