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Severe acute pancreatitis caused by high blood glu

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PostWysłany: Wto 11:02, 19 Kwi 2011    Temat postu: Severe acute pancreatitis caused by high blood glu

Severe acute pancreatitis caused by high blood glucose monitoring and nursing care

Key words severe acute pancreatitis; high blood sugar; monitoring; care severe acute pancreatitis (SAP) is a non-biliary cause of biliary and other trypsin within the pancreas caused by activation, resulting in pancreatic tissue self-digestion, edema, hemorrhage and necrosis of the inflammatory response [1], often accompanied by severe metabolic disorder. The incidence of sudden, rapid progress of the disease, varying degrees of damage caused pancreatic endocrine disorders, high blood sugar symptoms, both in critical condition and high blood sugar targets, but also increase the SAP disease, so good blood glucose control can significantly improve the severe pancreatitis prognosis [2]. May 2007 -2008 in May, admitted to our department SAP 20 cases were associated with high blood sugar, respiratory distress, after the ICU stay to strengthen monitoring of blood glucose, blood glucose control using insulin micro pump and other comprehensive treatment, 18 cases into the ward in stable condition after patients to continue treatment, 2 patients were complicated by multiple organ failure and death. Chinese papers League finishing. 1 clinical data 1.1 General Information 2007 年 5 月 至 2008 年 5 months, our department were treated SAP associated with high blood sugar, respiratory distress 20 patients, 12 males 8 females, aged 40 to 78 years, mean age 62 years, had no history of diabetes at admission. Main symptoms: upper abdominal pain, fever, hematuria, elevated amylase, abdominal CT, B extra fine diagnosed as respiratory distress into the ICU, when the fasting blood glucose into 12.6 ~ 30.4mmol / L, breathing 28-45 times / min, PaO2 45 ~ 70mmHg, PaCO2 normal, the non-invasive mechanical ventilation, fasting, gastrointestinal decompression, anti-inflammatory, enzyme inhibition acid suppression, control of blood glucose, correct water and electrolyte balance, energy, and comprehensive treatment supplement, 1 to 2 days of fasting blood glucose control in 10 mmol / L of about 3 to 5 days fasting blood glucose to normal 4.4 ~ 6.1 mmol / L, the majority of patients the disease under control. 1.2 treatment with short-acting insulin (10 ml: 400 U) 50U + saline 50 ml, per 1 ml solution containing insulin 1 U, use of micro-pump control dose, single administration of intravenous access, according to blood glucose levels regulation of insulin dose, blood glucose> 31.0mmol / L, insulin 8 ~ 10U / h pump maintenance, half an hour to 1 hour monitoring of blood glucose; 16.0 ~ 31.0mmol / L, insulin 4-6 U / h, 1 ~ 2 小时monitoring of blood glucose; 12 ~ 15.9mmol / L, insulin-2U / h, 4-hour monitoring blood glucose; 8 ~ 10mmol / L, insulin to 0.5 ~ 1.0U / h pump maintenance, monitoring of blood glucose 6 to 8 hours; ultimate goal of control of blood glucose In the 4.4 ~ 6.1mmol / L. If blood glucose levels can increase blood glucose fluctuations, dynamic monitoring of blood glucose values. 1.3 Results 18 patients, the disease under control, normal blood glucose, respiratory function recovery go to the ward, 2 patients were sicker, leading to multiple organ failure and death. 2 2.1 General Nursing Care strengthen psychological care, basic care,[link widoczny dla zalogowanych], to maintain a comfortable supine position, make the tube and respiratory care, to help turn around shot back, breathe and effective guidance cough and expectoration method; were forbidden to drink fasting, gastrointestinal decompression, early parenteral nutrition support, inform the patient of disease-related knowledge and the importance of fasting, guidance and care of patients with the treatment correctly. 2.2 care doctor to give anti-inflammatory medication, acid-suppressing enzyme inhibition, correction of electrolyte balance, blood glucose control, parenteral nutritional supplement comprehensive treatment of energy in the sugar solution and parenteral nutrition by glucose: insulin to 4 ~ 6g: 1U standard addition, while insulin micro pump to maintain strict control of input speed, making rapid and steady decline in blood sugar, control blood sugar in the ideal range. Close observation of the efficacy, attention to drug incompatibility, avoid using the drug increased blood sugar, insulin use single-channel delivery, to avoid drugs and speed up the bolus infusion, leading to inaccurate dosage blood sugar fluctuations. xxxxxxxxxx

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