胰岛素皮下注射控制糖尿病应激性高血糖临床观察

Clinical observation of subcutaneous injection of insulin in controlling diabetes stress hyperglycemia

目的观察胰岛素控制糖尿病应激性高血糖疗效并选择合理给药方式。方法 115例住院2型糖尿病合并急性应激性高血糖患者,分别给予胰岛素连续皮下输注及多次皮下注射强化治疗,观察血糖控制情况及血糖达标（空腹血糖4.4~8.0 mmol/L,餐后血糖4.4~10.0 mmol/L）的时间以及胰岛素用量。结果 2组患者采用胰岛素治疗后空腹、餐后血糖均明显下降,治疗前后差异有统计学意义（P〈0.01）,胰岛素治疗后前6 d 2组间比较差异有统计学意义（P〈0.05）。连续皮下输注胰岛素（CSII）组血糖控制达标时间（2.5±1.1）d,较多次皮下注射胰岛素（MSII）组（6.5±2.3）d明显缩短;达标时胰岛素用量（44±11）U/d,与MSII组（44±12）U/d无明显差异;CSII组低血糖发生率1.7%明显低于MSII组15.8%（P〈0.01）;CSII组手术患者切口感染率为0,明显低于MSII组5.3%（P〈0.01）;手术拆线时间CSII组（4.8±0.8）d低于MSII组（6.3±1.2）d。结论经过胰岛素强化治疗,2型糖尿病患者应激性高血糖控制理想;CSII较MSII更快速、有效、安全。

Objective To investigate the effect of insulin in controlling diabetes stress hyperglycemia,and to exlore a rational administration way.Methods 117 patients with type 2 diabetes complicated by acute stress hyperglycemia were given continuous subcutaneous insulin infusion（CSII group） or multiple times subcutaneous insulin injection（MSII group） for intensive treatment,and the control state for blood glucose,the time of blood glucose up to the standards（FBG 4.4~8.0 mmol/L,2h BG 4.4~10.0 mmol/L） and the dosage of insulin application each day were observed in the two groups.Results The levels of fasting and postprandial blood glucose were significantly decreased in both groups after treated with insulin（P 0.01）,and after 6-day treatment with insulin there was a significant difference in the levels of fasting and postprandial blood glucose between the two groups（P0.05）.and the time of blood glucose up to the standards in CSII group（2.5±1.1）d was significantly shorter than that（6.5±2.3） d in MSII group;there was no significant difference in the dosage of insulin administration at the time of blood glucose up to the standards between CSII group and MSII group [（44±11）U/d vs（44±12）U/d];the incidence of hypoglycemia in CSII group（1.7%） was significantly lower than that（15.8%） of MSII group（P0.01）;the incidence of postoperative infection rate in CSII（0） was significantly lower than that（5.3%） in MSII group（P0.01）;postoperative disconnecting time in CSII group（4.8±0.8）d was lower than that（6.3±1.2）d in MSII group.Conclusion The insulin intensive therapy can effectively control stress hyperglycemia in patients with type 2 diabetes,and CSII way is superior to MSII one,which is more rapid,effective and safe.