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ORIGINAL ARTICLE
Year : 2019  |  Volume : 32  |  Issue : 4  |  Page : 1185-1190

Hyperinsulinemic–normoglycemic technique in patients with cirrhosis undergoing hepatic resection: a randomized controlled trial


1 Department of Intensive Care Unit, Faculty of Medicine, Menoufia University, Shebeen El-Kom, Egypt
2 Department of Intensive Care Unit, Faculty of Medicine, Benha University, Benha, Egypt

Correspondence Address:
Mohammed Z Khalil
El-Gomohorya Street, Menoufia 11711
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mmj.mmj_18_18

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Objective To evaluate the efficacy of hyperinsulinemic–normoglycemic clamp technique (HNCT) versus the insulin sliding scale for glycemic control in patients with cirrhosis undergoing hepatic resection. Backgrounds There is a consensus in the published literature about the increased risk of hyperglycemia among patients undergoing hepatic resection. Previous reports have established the significant association between hyperglycemia and the extent of hepatic injury in hepatectomized patients. Patients and methods A randomized controlled trial was conducted on 60 patients with cirrhosis who underwent hepatic resection. Patients were randomly assigned to either HNCT group control (n = 30) or insulin sliding scale group (n = 30). The postoperative liver function was assessed by the score proposed, and patients were followed for 1 week postoperatively. Results The mean operative durations of HNCT study and control groups were 4.4 and 4.3 h, respectively. Moreover, 60% of the study group had a focal resection, whereas 60% of the control group had multiple resection operation. Postoperatively, HNCT group showed a statistically significant marked reduction in Schindl score compared with the control group (P < 0.001). In addition, HNCT group showed a marked improvement in postoperative liver parameters compared with the control group (P < 0.001). Conclusion HNCT significantly attenuates hepatic dysfunction and improves clinical outcomes postoperatively.


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