人胰岛素类似物在糖尿病围手术期应用疗效观察

Observation of the curative effect of insulin human analog in the application on diabetic patients during perioperative period

目的探讨速效人胰岛素类似物门冬胰岛素（诺和锐）与长效人胰岛素类似物甘精胰岛素（长秀霖）在2型糖尿病（T2DM）患者围手术期应用的有效性、安全性及顺应性。方法在行大中型手术的T2DM患者中随机挑选三组，每组各20例，A组使用诺和锐＋长秀霖，B组使用基因重组人胰岛素（优泌林R）＋精蛋白锌基因重组人胰岛素（优泌林N），C组使用胰岛素泵（优泌林R5例，诺和锐15例），所有患者均监测餐前、餐后2h及睡前血糖，部分患者加测凌晨0～3点血糖，并在手术过程中监测血糖。结果三种不同胰岛素强化治疗均可使血糖达到控制目标，使患者顺利渡过围手术期，达到伤口愈合。A组低血糖发生率为10％，患者满意率为95％；B组低血糖发生率为30％，患者满意率为70％；C组低血糖发生率为5％，患者满意率为100％。结论人胰岛素类似物具有良好的血糖控制效果，使用安全方便，患者的顺应性好，将其应用于糖尿病患者围手术期的血糖控制可行性高，值得推广。

Objective To study the efficacy, safety and compliance of insulin human analog insulin aspart （NovoRapid） and insulin zinc protamine analog （Basulin） in the application on type 2 diabetes mellitus（T2DM）patients during perioperative period. Methods Sixty T2DM patients were divided into 3 groups （n=20）. Group A was treated with NovoRapid ＋ Basulin, group B was treated with insulin human （ Humulin R ＋ Humulin N） and group C was treated with insulin pump （ Humulin and NovoRapid）. Blood glucose was detected in all of the patients before the meal, 2 hours after meal, before the sleep and during the operation. Results Blood glucose could all achieve the control level with the three methods of treatment. The rates of hypoglycemia in the three groups were 10%, 30% and 5% respectively, and the rates of patient satisfaction were 95%, 70% and 100% respectively. Conclusions Insulin human analog could control blood glucose effectively and safely, the compliance is also high. It is feasible of applying insulin human analog in the blood glucose control during perioperative period.