胰岛素泵和多次胰岛素皮下注射在2型糖尿病患者择期手术围手术期临床应用的比较

Comparison between insulin pump or multiple subcutaneous insulin injection therapy on perioperative diabetes patients

目的比较T2DM患者择期手术围手术期胰岛素泵(CSII)或每日多次皮下注射胰岛素(MSII)的效用及花费。方法选取近2年外科、妇科择期手术的T2DM患者56例,随机采用CSII或MSII治疗,比较血糖控制、围术期感染及治疗费用。结果 CSII、MSII组治疗后血糖均较治疗前降低(P均<0.01),两组间比较差异无统计学意义(P>0.05)。CSII组血糖达标时间、胰岛素总量均较MSII组低[(3.0vs4.0)d,(39.07±3.15)vs(44.27±4.33)U,P<0.05];CSII组手术切口愈合时间、抗菌素使用天数及抗菌素使用费用较MSII组降低[(7.03±1.40)vs(8.10±1.63)d,(4.14±1.25)vs(5.26±1.75)d,(688vs908)元,P<0.05]:住院天数缩短[(11.03±1.82)vs(14.91±2.47)d,P<0.05],非手术费用差异无统汁学意义。结论与MSII比较,CSII能更有效地控制嗣手术期患者的血糖,减少低血糖发生、围术期感染及住院费用。

Objective To compare the efficacy and cost between insulin pump（CSII） and multiple daily subcutaneous injection of insulin（MSII） therapy on T2DM patients in the per＋operative phase. Methods Fifty-six T2DM patients undergoing surgery in resent two years were randomized into CSII or MSII groups. Blood glucose level, incidence of hypoglycemia, incision healing status and costs were compared. Results After treatment,the levels of FBG and 2 hBO were significantly decreased[FBG （5.92 ±0.79） vs （6.21±0. 87） ,2 hBG（8. 37±1.57） vs （9.14±1.38） ,P〈0.05 ]. The time for targeting blood glucose, the amount of insulin dosage and the hypoglycemia incidence were significantly decreased in cslI group as compared with MSII group[3.0 vs 4.0 d, （39.07±3.15） vs （44.27±4. 33）U,P%0.05]. The incidence of postoperative infection rate, the incision healing time , the days of using antibiotics and cost of antibiotic use in CSII group significantly less than that of MSII group[-（7.03±1.40） vs （8. 10±1.63） d, （4. 14±1.25） vs （5.26_± 1.75） d, 688 yuan（RMB） vs 908 yuan（RMB）, P〈0.05）, while the days of hospital stay were significantly shorten[（ll. 03±1.82） vs （14. 91±2.47） ,P〈0. 05],the costs were not increased. Conclusion CSII is superior to MSII therapy in its remarkable efficady and cost-benefits ratio.