胰岛素强化治疗在2型糖尿病骨折患者围手术期的应用

Application of strengthen subcutaneous insulin infusion in perioperation of bone fracture patients with type 2 diabetes mellitus

目的探讨骨折合并2型糖尿病患者围手术期控制血糖的最佳方法。方法2型糖尿病骨折患者随机分为胰岛素泵治疗组（CSII组，n=10，门冬胰岛素）、甘精胰岛素治疗组（GA组，n=20，门冬胰岛素＋甘精胰岛素）与重组人胰岛素N治疗组（NA组，n=20，门冬胰岛素＋重组人胰岛素N）。比较3组患者空腹和餐后2h血糖，血糖波动，所需胰岛素剂量，血糖达标时间，低血糖、黎明现象和感染发生例数，平均拆线时间及平均住院天数。结果治疗后CSII组、GA组和NA组空腹血糖[（6．32±1．18）、（6．25±0．88）、（7．44±1．36）mmol／L]和餐后2h血糖[（7．72-±1．53）、（7．32±1．17）、（8．52±_0．76）mmol／L]、所需胰岛素剂量[（35．40±1．60）、（36．20±0．80）、（40．50±2．40）IU]、血糖波动状况、血糖达标时间、低血糖、黎明现象和感染发生率、平均拆线时问及平均住院时间等各项指标相比较，CSII、GA组明显低于NA组（P〈0．05），而CSII组与GA组间差异无统计学意义，但GA组更经济、实用。结论胰岛素泵持续皮下注射和甘精胰岛素联合门冬胰岛素方案能迅速、有效、安全、平稳地控制全天血糖，可作为2型糖尿病骨折患者围手术期控制血糖强化治疗的首选方案。

Objective To investigate the best way to control the blood sugar level during the perioperation of bone fracture patients with type 2 diabetes mellitus （T2DM）. Methods Bone fracture patients with T2DM were randomly divided into three groups： continuous subcutaneous insulin infusion group （insulin aspart, group CSII, n=20 ）, glargine treatment group （insulin aspart ＋ insulin glargine, group GA, n=20） , and NPH treatment （insulin aspart ＋ rh-insulin, group NA, n=20 ）.The levels of fasting plasma glucose （FPG） and 2 hours postprandial glucose （2h PG）, blood glucose fluctuation （BGF）, insulin dosage （ID） , good effective time （GET） , incidence of hypoglycemia, dawn phenomenon and infection, average time of stitches removal （ATSR） , average hospitalized length （AHL） of three groups were compared. Results FPG and 2hPG, ID in group CSII [ （6.32±1.18） mmol/L, （7.72±1.53）mmol/L, （35.40±1.60）1U] and group GA [ （6.25±0.88） mmol/L, （7.32±1.17） retool/L, （36.20±0.80） IU] were significantly lower than those of group NA [ （7.44± 1.36）mmol/L, （8.52±0.76） mmol/L, （40.50±2.40）IU, all P〈0.05]. Simultaneously, BGF, GET incidence of complications, ATSR, AHL of group CSII and GA were significantly lower than those of group NA （all P〈0.05）. There were no significant differences between group CSII and group GA. Compared with group CSII, group GA had less costs in-hospital and better practicability. Conclusion Both CSII and insulin glargine combined with insulin aspart can effectively, safely, rapidly and stablely control hyperglycemia, which should be the first choice to control blood sugar for bone fracture patients with T2DM in perioperation.