2型糖尿病病人围手术期应用胰岛素泵输注诺和锐控制高血糖的临床研究

Perioperative hyperglycemia control with insulin aspart injection used in insulin pump in patients with type 2 diabetes mellitus

目的通过研究胰岛素泵持续皮下注射速效人胰岛素类似物(诺和锐)对2型糖尿病病人围手术期血糖的控制情况,探讨糖尿病病人围手术期最佳的血糖控制方法及药物。方法选择60例住院手术的2型糖尿病病人,随机血糖均>20mmol/L,按照自愿的原则分为两组,A组采用诺和锐CSII治疗,B组采用多次皮下胰岛素注射治疗(MSII),观察每组病人治疗前后及两组间治疗后各项临床指标变化。结果两组病人治疗后血糖都明显下降(P<0.01),诺和锐CSII组餐后2h血糖明显低于MSII组(P<0.01),术中血糖明显低于MSII组(P<0.01),胰岛素用量也少于MSII组(P<0.01)。诺和锐CSII组达到血糖良好指标的时间及平均术前住院天数也少于后者(P<0.01)。低血糖发生也较少。结论胰岛素泵持续皮下注射诺和锐能迅速、有效、安全、平稳地控制全天血糖,明显优于传统皮下多次注射胰岛素,是2型糖尿病病人围手术期控制血糖强化治疗的首选方案及药物。

Objective To study the plasma glucose status of patients with type 2 diabetes mellitus （T2DM） in perooperative period after adopting continuous subcutaneous insulin injection（CSII） by using aspart in insulin pump and, to investigate the best plasma glucose control methods and drugs for diabetic patients in perioperative period. Methods Chose 60 patients with T2DM receiving operation, with a random plasma glucose level of 20 mmoL/L or more, and divided them into 2 groups randomly. Patients in group A accepted aspart CSII treatment and patients in group B accepted multi -subcutaneous insulin injection（MSII） treatment. The changes of some clinical indexes of each group were observed before and after treatment. Results The plasma glucose level of patients in both groups dropped evidently after treatment（ P 〈 0.01 ）. The glucose 2h after meal or during the operation in aspart CSII group were lower than that in MSII group with less insulin dosage. The good effective time and average admission day before the operation were shorter in aspart CSII group than those in MSII group（ P 〈 0.01 ）. Conclusion The aspart CSII can control the hyperglycemia effective, safe, rapid and smooth. It might be the first choice for patients with T2DM in perioperative period and have better effect than traditional method and drug.