甘精胰岛素用在2型糖尿病合并上消化道出血的生物学探讨

Biological Discussion of Insulin Glargine Used in Type 2 Diabetic Patients with Upper Gastrointestinal Bleeding

目的通过分析甘精胰岛素治疗2型糖尿病合并上消化道出血急性期血糖控制的优势,评价其生物学特点。方法选取46例上消化道出血合并糖尿病的患者,随机分为两组:A组23例,治疗方法采用静脉点滴葡萄糖时加用中和量短效胰岛素,并于早晨8时皮下注射甘精胰岛素,根据空腹血糖调整用量;B组23例,静脉点滴葡萄糖时加用中和量短效胰岛素,根据随机血糖结果调整短效胰岛素用量。两组随机血糖控制目标值均在10.0mmol/L以下,且内科止血治疗措施基本相同。通过观察患者黑便、胃管内抽取物、低血糖症状、日均血糖的平均指标、胰岛素用量和便潜血转阴时间等指标,评价甘精胰岛素在治疗中的优势,并进行生物学特性分析。结果 A组日均血糖(9.6±1.1)mmol/L,甘精胰岛素总量为(16±1.2)U,中和量短效胰岛素用量为(20±3.5)U,未出现低血糖现象;B组日均血糖值控制在(11.6±0.7)mmol/L,短效胰岛素用量平均(50±4.2)U,有3人出现低血糖现象,两组间有显著统计学差异,P<0.05;两组便潜血转阴时间相同。结论提示在消化道出血急性期间,用甘精胰岛素控制血糖,病人低血糖反应少,胰岛素用量小,此源于其良好的生物学特性。

Objective To evaluate the advantages of blood glucose control while insulin glargine are used for type 2 diabetic patients with upper gastrointestinal bleeding in acute phase, by means of analyzing its biological characteristics. Methods forty-six cases of upper gastrointestinal bleeding with diabetes mellitus were randomly divided into A and B groups, and 23 cases involved in each group. For group A, the blood glucose was control by intravenous glucose added the short-acting insulin and subcutaneous insulin glargin at 8：00am, adjusting the dosage according to fasting blood glucose. For B group, the blood glucose was control only by intravenous glueose added the short-acting insulin, which dosage was adjusted according to the values of random blood glucose. The random blood sugar control targets in both groups were in 10. Ommol/L. Additionally the ways of hematischesis treatment were same in two groups. The advantage of subcutaneous insulin glargine was estimated by observing following indexes of patients, such as black excrement, samples from stomach, hypoglycemia symptom, the daily average of blood sugar, insulin amount used each day, and occult blood clearance time. Results Comparing between A and B groups, the observation result suggested that the type 2 diabetic patients with upper gastrointestinal bleeding, who were treated by subcutaneous insulin glargine, seldom occur hypoglycemia symptom and used fewer small dosage of insulin. The , that stems from insulin glargine＇ s good biological characteristics.