持续静滴胰岛素改善ELBW糖耐量的疗效评估

目的探讨持续静脉滴注胰岛素改善进行部分静脉营养(PPN)的超低出生体重儿(ELBW)糖耐量的疗效,并对其安全性进行评估. 方法运用电脑微量输液泵持续静脉滴注胰岛素的方法对15例日龄3～15d、孕周25.3～28W、出生体重<1000g的ELBW高血糖症(>9mmol/L)进行治疗,根据不同血糖浓度调节静脉滴注胰岛素的速度,同时监测血糖浓度(q1～4h),观察血糖下降到正常的时间及低血糖发生率,在血糖浓度<9mmol/L时逐渐停用胰岛素. 结果 15例ELBW血糖浓度为(12.6±1.9)mmol/L,开始治疗时间为(132.2±57)h;静脉滴注胰岛素的速度为(0.08±0.32u)/(kg·h);高血糖持续时间为(160.9±34.8)h,胰岛素持续应用时间为(223.4±77.8)h,血糖恢复正常时间为(30.4±17.8)h;补葡萄糖速度为(17±2mg)/(kg·min),达到完全热卡时间为(166±31)h.其中2例出现低血糖. 结论持续静脉滴注胰岛素能安全、有效地改善ELBW对葡萄糖的耐受性,使ELBW获得足够的热卡,达到能量需求,使糖耐量低下的ELBW增加体重.

Objective To determine the efficiency and safety of improvement the glucose tolerance in continuous insulin intravenous infusion for extremely low birth weight infants（ELBW）. Methods 15 cases of ELBW were received continuous intravenous infusion and partial parenteral nutrition （PPN）. Continuous infusion of insulin was used when the concentration of serum blood glucose above 9.0mmol/L. The insulin dose were regulated according to the concentration of blood glucose. But the speed of infusion glucose was not changed and increased 0.5 - 1mg/kg·in each day;. They were monitored the concentration of glucose every 1 - 4 hours and checked serum blood glucose every day. While the serum blood glucose less than 9.0mmol/L and steady for 8 hours, infusion insulin was stopped gradually. Observing the speed of infusion glucose, the time of arriving full caloric intake （ 110Kcal/kg· day） and the rate of hypoglycemia. Results The average concentration of blood glucose in 15 cases of ELBW were （12.6 ± 1.9）mmol/L（9.2 ± 18.6mmol/L）. The time of starting treatment, hyperglycemia , continuous infusion of insulin, serum blood glucose recovering normal and arriving full caloric（ 110kcal/kg· day） was （132.2 ± 57）h（43 ± 106h）, （160.9 ± 34.8）h （98 ± 264h）, （223.4 ± 77.8）h, （30.4 ± 17.8） （8 ± 60h）and （ 166 ± 31 ）h respectively. The average speed of infusion insulin was （0.08 ± 0. 32u ）/kg·h （0.06 - 0. 42u ）/（ kg·h ） and the speed of infusion glucose was （ 17 ± 2 ） mg/kg · min. But the hypoglycemia was only 2 cases （ 13.3 % ）. Conclusion It appears efficiency and safety for those ELBW in hyperglycemia and increase body weight steadily through improving glucose tolerance and maintaining normal caloric intake with continuous infusion of insulin.