2型糖尿病合并骨折患者围手术期胰岛素泵的应用

Value of Insulin Pump Treatment in Perioperative Type 2 Diabetes Patients Accompanied with Fracture

目的评价围手术期胰岛素泵治疗与多次皮下注射胰岛素治疗的效果.方法2型糖尿病患者合并股骨颈骨折32例、股骨转子间骨折18例,随机分为胰岛素泵治疗组（CSII组）26例与多次皮下注射胰岛素组（MDII组）24例,测定两组患者血脂、肝肾功能和C肽水平,进行多点血糖监测,评价两种治疗方法在血糖控制和胰岛素用量方面的差异.结果在年龄、病程、BMI、C-肽、空腹血糖、血脂、肝肾功等方面,两组无显著性差异（P均〉0.05）.与MDII组相比较,血糖达标时CSII组空腹血糖水平更低（P〈0.05）,每日胰岛素总量/体重、基础量/每日胰岛素总量及餐前量/每日胰岛素总量更少（P均〈0.05）,低血糖和严重低血糖发生例数更少.结论围手术期胰岛素泵治疗较传统多次皮下胰岛素注射治疗,血糖控制更加平稳、低血糖反应更少、胰岛素用量更少.

Objective To evaluate insulin pump and multiple daily insulin injection in perioperative type 2 diabetes accompanied with fracture.Methods Fifty cases of type 2 diabetes patients,32 cases accopanied with femoral neck fracture and 18 cases with femoral intertrochanteric fracture ,were randomly divided into insulin pump treatment group（CSII group）（n=26） and multiple daily insulin injections group （MDII group）（n=24）.The blood ketone and lipid analysis,liver and kidney function and c-peptide levels were measured.Finger blood glucose was monitored seven times a day,hypoglycemia was recorded and insulin dosage was evaluated when blood glucose reached the goal .Results No difference was found in age,history,body mass index,c-peptide,blood lipid,fasting plasma blood glucose,liver function and kidney function between the two groups （P〉0.05）.Compared with MDII group,fasting blood glucose was lower when reached the operation goals（P〈0.05）.Compared with MDII group,daily overall dose of insulin/weight,bas-al/overall dosage of insulin and bolus/overall dosage of insulin was significantly lower than MDII group （P〈0.05）. Conclusion Compared with MDII,blood sugar was more stable,the hypoglycemia was less in CSII group .Less dose of insulin was used in CSII group than that of MDII group .