胰岛素持续皮下注射治疗糖尿病合并脑卒中38例疗效观察

Therapeutic effect of the continuous subcataneous insulin infusion treatment on the diabetic patients with cerebral apoplexy

目的比较不同胰岛素给药方法治疗糖尿病合并脑卒中的疗效。方法将76例糖尿病患者分为胰岛素泵持续皮下注射(CSII)组及胰岛素多次皮下注射(MSII,4次/d)组。静脉输注5%葡萄糖溶液者,CSII组每4g葡萄糖同步增加基础量胰岛素1U;MSII组用微量注射器同步静脉注射胰岛素1U。结果治疗期间血糖平均值、血糖达标时间、低血糖(血糖<2.78mmol/L)发生率两组间比较,差异均有统计学意义[(7.86±1.15)vs(10.05±1.87)mmol/L;(3.53±1.16)vs(6.49±2.75)d;23.7%vs 57.9%,P<0.01];治疗后14d,两组间神经功能缺损程度(NIHSS)比较,差异有统计学意义[(21.63±4.73)vs(24.06±5.15)分,P<0.05];两组间并发症发生率、死亡率比较,差异无统计学意义(23.7%vs 39.5%,5.3%vs 10.5%,P>0.05)。发病后3个月,两组Barthel指数评分比较,差异有统计学意义(P<0.05)。结论 CSII治疗糖尿病合并脑卒中,在血糖控制和神经功能恢复方面疗效优于MSII。

Objective To compare the effect of different approaches to insulin administration on the diabetic patients with cerebral apoplexy. Methods Seventy-six diabetic patients with cerebral apoplexy were randomly divided into CSII group who were treated by continuous subcutaneous insulin infusion （CSII） of insulin aspart with insulin pump and MSII group who were treated by Multi-subucutaneous insulin injection（MSII）. The initial basal rate of 1 U insulin aspart per 4 g glucose was increased for CSII group and the dosage of 1 U insulin was infused by intravenous injection with micro-pump for MSII group for the patients receiving glucose solution by intraveneous drip. Results The average glycemia, glucose-targeting time, the hypoglycemia events rate （glycemia〈2.78 mmol/L） during treating were significantly different [（7.86±1.15）vs （10.05±l. 87）mmol/L; （3.53±1.16） vs （6. 49 ± 2. 75） d; 23. 7% vs 57.9%, P（0.01]. NIHSS score at 14 days during treating was significantly different [（21.63±4. 73）vs （24. 06±5.15）points,P〈0.05]. The complication rate, the death rate were not significantly different（23.7o/oo vs 39.5±5.3% vs 10.5%,P〈0. 05）. Conclusion The efficacy of CSII therapy on the decreasing blood glucose and neuro-functional recovery in diabetic patients with cerebral apoplexy is superior to MSII therapy