应用全静脉营养时胰岛素不同的给药方法对患者血糖和尿糖的影响

The effect of different administration of insulin on blood and urine glucose level in patients with total parenteral nutrition

目的:探讨胰岛素在全静脉营养时不同的给药方法对患者血糖和尿糖的影响。方法:将2008年1～12月我科食管贲门癌术后患者,在相同的TPN配方条件下选择60例,并随机分为对照组和实验组各30例,对照组诺和灵R(中效胰岛素)采用静脉营养袋以微量泵的形式按比例同步泵入;实验组则将诺和灵R加入全合一营养袋里输注,两组患者均采用相同的输液泵和输液速度进行控速管理。分别测量两组患者在开始输注营养液时、输注1000ml时、输注2000ml和剩余100ml时所对应时点的血糖和尿糖(连续测7d)以及所对应时点的胰岛素的浓度和活性(保留3d)。结果:两组给药方法各时点胰岛素的活性百分比无明显差异(P>0.05),胰岛素的活性随时间的延长而活性稍降低;两组各时点的胰岛素浓度相互之间无明显差异(P>0.05);两组组内,组间各时点的血糖及尿糖均无明显差异(P>0.05);两组低血糖的发生率无明显差异(P>0.05)。结论:为了减轻临床护士的工作量,将胰岛素加入营养袋中进行输注是可行的。

Objection：To compare different ways of administration of insulin and their effects on the blood glucose and urine glucose in patients with total parenteral nutrition（TPN）.Methods：From January 2008 to December 2008,60 consecutive patients after gastrointestinal operations were randomly divided in to two groups,30 patients in each gracp.insulin was administrated in syringes（control group）,while in other 30 patients insulin was added directly into ＂all in one＂ bag（test group）.Blood glucose and urine glucose levels were monitored for 7 days after operation, as activation and concentration of insulin were measured at beginning infusion,infused 1000 ml,infused 2000 ml, and remained 100 ml daily for the first 3 days. Results： There was no significant difference of activation of insulin between the two groups（ P 〉0.05） ;There was a tendency of decrease for the activation of insulin in two groups with the time ;There was no significant difference of the concentration of insulin between two groups in the four time points ; there was no significance between blood and urine glucose levels in either test group （ P 〉 0.05 ）, and there was no significant difference of hypoglycemia between the two groups （ P 〉 0.05 ）. Conclusion： Thus, adding insulin into the ＂all in one＂ bag is feasible for the sake of alleviating nurses＇ workload.