Strict blood glucose control by an artificial endocrine pancreas during hepatectomy may prevent postoperative acute kidney injury
Strict blood glucose control by an artificial endocrine pancreas during hepatectomy may prevent postoperative acute kidney injury
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DOI：
10.1007/s10047-016-0925-6
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发表时间：
2017-03-01
影响因子：
1.3
通讯作者：
Tanaka, Katsuya
中科院分区：
文献类型：
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作者：
Mita, Naoji;Kawahito, Shinji;Tanaka, Katsuya
本研究的目的是评价闭环系统（STG-55; Nikkiso，Tokyo，Japan）的有用性，一种用于连续监测和控制术中血糖的人工内分泌胰腺，用于预防接受肝切除术的患者术后急性肾损伤（阿基）。38例患者入组本研究。通过基于常用滑动标尺的手动胰岛素注射（手动胰岛素组，n = 19）或通过人工内分泌胰腺的控制算法确定的程控胰岛素输注（程控胰岛素组，n = 19）控制葡萄糖浓度。麻醉诱导后，程序胰岛素组患者前臂外周静脉插入20-G静脉导管，并连接到人工内分泌胰腺（STG-55）。葡萄糖浓度的目标范围设定为100-150 mg/dL。程序胰岛素组术前、术后24和48 h的平均血清肌酐浓度分别为0.72、0.78和0.79 mg/dL，手动胰岛素组分别为0.81、0.95和1.03 mg/dL。在程序胰岛素组中，术后48小时血清肌酐浓度的升高被显著抑制。STG-55闭环系统可有效维持肝切除术期间严格的血糖控制，血糖浓度变异性最小，并可抑制血清肌酐浓度升高。在肝切除术期间通过人工内分泌胰腺严格控制血糖可以预防术后阿基。
The aim of the present study was to evaluate the usefulness of a closed-loop system (STG-55; Nikkiso, Tokyo, Japan), a type of artificial endocrine pancreas for the continuous monitoring and control of intraoperative blood glucose, for preventing postoperative acute kidney injury (AKI) in patients undergoing hepatectomy. Thirty-eight patients were enrolled in this study. Glucose concentrations were controlled with either a manual injection of insulin based on a commonly used sliding scale (manual insulin group, n = 19) or the programmed infusion of insulin determined by the control algorithm of the artificial endocrine pancreas (programmed insulin group, n = 19). After the induction of anesthesia, a 20-G intravenous catheter was inserted into the peripheral forearm vein of patients in the programmed insulin group and connected to an artificial endocrine pancreas (STG-55). The target range for glucose concentrations was set to 100-150 mg/dL. The mean serum creatinine concentrations of preoperative, postoperative 24 and 48 h were 0.72, 0.78, and 0.79 mg/dL in the programmed insulin group, and 0.81, 0.95, and 1.03 mg/dL in the manual insulin group, respectively. Elevations in serum creatinine concentrations postoperative 48 h were significantly suppressed in the programmed insulin group. The STG-55 closed-loop system was effective for maintaining strict blood glucose control during hepatectomy with minimal variability in blood glucose concentrations and for suppressing elevations in serum creatinine concentrations. Strict blood glucose control by an artificial endocrine pancreas during hepatectomy may prevent postoperative AKI.