胰岛素泵治疗糖尿病酮症酸中毒伴发肾功能不全的临床研究

Effect of continuous subcutaneous insulin infusion by insulin pump in treatment of diabetic ketoacidosis with renal inadequacy： clinical study of 32 cases

目的比较胰岛素泵持续皮下胰岛素输注法（CSⅡ）与传统小剂量胰岛素静脉点滴法治疗糖尿病酮症酸中毒（DKA）伴发肾功能不全的短期疗效。方法DKA并发肾功能不全患者36例，随机均分为CSⅡ组（用胰岛素泵经导管持续皮下输注短效生物合成人胰岛素）和对照组（给予小剂量短效生物合成人胰岛素静滴）。结果CSⅡ组酮体平均消失时间为（22．94±7．89）h，显著短于对照组（38．22±12．29）h，P〈0．05]。CSⅡ组肾功能恢复时间（4．11±2．05）d，显著短于对照组[（6．72±2．87）d，P〈0．051。CSⅡ组调整期各时点（除凌晨3点）的空腹血糖值均低于对照组（均P〈0．05）。CSⅡ组低血糖事件发生次数明显少于对照组（P〈0．05）。结论CSⅡ能更有效地治疗DKA，能更快地改善肾功能，使血酮体转阴，降低低血糖发生率。

Objective To investigate the short term effects of continuous subcutaneous insulin infusion （CSII） and in the treatment of diabetic ketoacidosis （DKA） with renal inadequacy. Methods Thirty-two DKA patients were randomly divided into 2 equal groups： CSII group undergoing short term continuous subcutaneous insulin infusion of biosynthetic short-acting human insulin using insulin pump, and control group undergoing intravenous drip infusion of biosynthetic short-acting human insulin. Results The blood ketone disappearance time of the CSII group was （22.94±7.89） h, significantly shorter than that of the control group [ （38.22± 12.29） h, P 〈0.05]. The renal function recovery time of the CSII group was （4.11 ±2.05 ）d, significantly shorter than that of the control group [（6.72±2.87 ）d, P 〈0.05]. The values of fasting blood sugar at different time points of the CSII gToup were all significantly lower than those of the control group （all P 〈0.05）. The number of hypoglycemia event of the CSII group was significantly lower than that of the control group （P 〈0.05）. Conclusion CSII is more effective in treatment of diabetic ketoacidosis with renal inadequacy.