应用胰岛素泵治疗儿童1型糖尿病合并酮症酸中毒

Treatment of type-1 diabetes mellitus and ketoacidosis with insulin pump

目的 探讨使用胰岛素泵持续皮下输注胰岛素治疗儿童 1型糖尿病合并酮症酸中毒的可行性。方法 将在我院住院的 1型糖尿病合并酮症或酮症酸中毒的患儿 12例 ,分为胰岛素泵治疗组和对照组 ,每组 6例。分别使用胰岛素泵皮下输注胰岛素和小剂量胰岛素静脉滴注 ,常规胰岛素的用量为 0 .0 5～ 0 .10IU/ (kg·h) ,观察血糖、β 羟丁酸、尿酮体的变化。 结果 ( 1)两组患儿的血糖在使用胰岛素泵和静脉小剂量胰岛素滴注治疗后均明显下降 ,两组血糖治疗前后的下降值差异无显著意义。 ( 2 )两组患儿的血 β 羟丁酸在治疗后均恢复正常 ,胰岛素泵治疗组患儿恢复正常的时间 [( 2 .0±0 .9)d]短于对照组 [( 6 .3± 1.8)d],两组差异有非常显著意义 (t=5 .45 ,P <0 .0 1)。 ( 3)胰岛素泵治疗组患儿治疗后尿酮体转阴时间为 ( 6± 3)h ,对照组为 ( 12 8± 45 )h ;两组差异有非常显著意义 (t=6 .6 5 ,P <0 .0 1)。结论 胰岛素泵用于治疗 1型糖尿病合并酮症酸中毒可以取得比对照组更加满意的疗效。

Objective To investigate the feasibility of treating children with diabetic ketoacidosis (DKA) by using insulin pump. Method Twelve children with DKA were divided to two groups with 6 cases in each: control group and insulin pump treated group (IP group). Children in the 2 groups were matched in age and blood glucose levels on admission. Children in both groups were treated with regular insulin at a dose range of 0.05～0.10 IU/(kg·h) which was administered via low dose intravenous infusion in the control group and by insulin pump in the IP group. The response rates of the 2 groups were compared. Results (1) The level of blood glucose in IP group decreased from (23±11) mmol/L of pretreatment level to (11±5) mmol/L 3 hours after treatment (t=3.47, P<0.05). The average blood glucose level of the control group decreased from (23±6) mmol/L of pretreatment level to 11±4) mmol/L 3 hours after treatment (t=4.30, P<0.05). The average value of decreased blood glucose in 2 groups was not significantly different. (2) The level of D3hydroxybutyrate decreased to normal [0.03～0.30 mmol/L] from 0.40～6.38 mmol/L for(2.0±0.9)days [1～3 days] in IP group and from 1.33～6.50 mmol/L for (6.3±1.8)days [3～8 days] in the control group after treatment. The recovering time of D3hydroxybutyrate in the 2 groups was significantly different (t=5.45, P<0.05). (3) It took (6±3) hours [3～12 hours] in IP group and (128±45) hours [72～192 hours] in the control group to reverse ketoacidosis, which were significantly different (t=6.65, P<0.05) in paired ttest. Conclusion Use of insulin pump showed more satisfactory effects than intravenous insulin infusion therapy in children with DKA.