住院2型糖尿病患者胰岛素泵的合理应用

Reasonable application of continuous subcutaneous insulin infusion in type 2 diabetic in-patients

目的探讨短期胰岛素泵强化治疗对2型糖尿病住院患者的应用方法，分析影响疗效及胰岛素用量的相关因素。方法对1276例2型糖尿病患者行胰岛素泵强化治疗，观察总体胰岛素泵应用情况，在初诊、老年伴肥胖或感染等特殊情况下胰岛素泵应用上的差别。结果胰岛素强化治疗后总体血糖在（5．7±2．6）d达标，达标时单位胰岛素用量为（0．69±0．31）U·kg^-1·d^-1；初诊组达标较快，达标后胰岛素减量更早，幅度更大，达到临床缓解的比例更高；老年组夜间基础率较低，且夜间低血糖发生的风险较大；伴肥胖组餐前胰岛素用量较大，但低血糖风险较低；伴感染组胰岛素用量较大，主要是基础率明显增加；血糖达标天数和胰岛素用量主要与感染、基础血糖及肥胖显著相关。结论对不同人群的连续皮下胰岛素输注应用方法存在着差别，患者的感染、基础血糖和肥胖指标有助于确定初始胰岛素用量。

Objective To study the regiments of continuous subcutaneous insulin infusion （CSII） in admitted type 2 diabetic patients, and to analyse the factors related to its effectiveness and insulin dosage. Methods A total of 1 276 type 2 diabetic patients were treated by CSII. The total efficacy of CSII was evaluted. The use of CSII was also analysed in the newly diagnosed patients, elderly patients, and patients with obese or infectious disease. Results The excellent control of blood glucose were achieved in （5.7 ± 2.6） days in the dosage of insulin （0.69 ± 0.31 ）U·kg^-1·d^-1 by CSII. The dosage of insulin were reduced more early and quickly in the newly diagnosed group than that in the previously diagnosed group after the blood glucose levels achieved good control. The percentage of the patients reached the clinical relieve was also higher in the newly diagnosed group. The incidence of hypoglycemia was significantly higher in the elderly patients with lower basal insulin dosage at night. The bolus insulin dosage in the obese patients was higher than that in the non-obese patients. The patients with infectious disease usually have a higher basal insulin dosage than those without infectious disease. The days needed for achieving good control of blood glucose and the insulin dosage were related to infectious factors, the basal blood glucose and obesity. Conclusion The application of CSII among the patients is varied with different conditions. Blood glucose level, body mass index and infection factors are important to determine the initial insulin dosage.