四种胰岛素注射方法治疗合并肺部感染的2型糖尿病的临床对比研究

Comparative Study on the Clinical Effects of Four Insulin Injection Methods on the Treatment for Type 2 Diabetes Complicated by Pulmonary Infection

目的比较不同胰岛素注射和给药方法对合并肺部感染的2型糖尿病患者的治疗效果。方法选取2011年4月至2013年8月重庆市第五人民医院内分泌科收治的合并肺部感染2型糖尿病患者275例,将其采用随机数字表法分为A组(69例)、B组(68例)、C组71例)和D组(67例)。A组给予门冬胰岛素30三餐前皮下注射;B组给予门冬胰岛素三餐前皮下注射联合甘精胰岛素睡前皮下注射;C组给予人胰岛素R三餐前皮下注射联合人胰岛素N睡前皮下注射;D组给予持续皮下胰岛素泵注射。4组患者均同时根据药敏试验给予抗生素治疗,于治疗3 d时对肺部感染治疗效果进行评价;于治疗前及治疗1周后测定4组患者空腹及早餐后2 h血糖水平;记录低血糖发生情况。结果 A、B、C、D组总有效率分别为76.8%、94.1%、87.3%和89.6%,B组疗效优于A组(P<0.05)。治疗前A、B、C、D组患者空腹血糖分别为(10.9±2.4)mmol/L、(12.4±3.6)mmol/L、(11.1±3.3)mmol/L和(12.2±2.6)mmol/L,早餐后2 h血糖分别为(17.4±2.0)mmol/L、(16.5±1.8)mmol/L、(16.3±3.5)mmol/L和(16.3±2.7)mmol/L,经过1周治疗后A、B、C、D组患者空腹血糖分别为(6.4±0.9)mmol/L、(5.2±2.0)mmol/L、(5.6±0.8)mmol/L和(5.1±1.1)mmol/L,早餐后2 h血糖分别为(8.3±1.4)mmol/L、(9.0±5.0)mmol/L、(10.0±3.8)mmol/L和(10.0±3.8)mmol/L,4组患者空腹血糖及餐后2 h血糖均较治疗前显著降低(P<0.01)。B、C、D组患者治疗后空腹血糖显著低于A组(P<0.05);4组患者治疗后早餐后2h血糖水平差异无统计学意义(P>0.05)。4组患者之间低血糖发生率比较差异无统计学意义(P>0.05)。结论门冬胰岛素30三餐前皮下注射方案降低空腹血糖效果较差,不适合在临床推广使用。

Objective To compare the effects of different methods of administration and insulin injec-tions on the treatment for pulmonary infection with type 2 diabetes.Methods A total of 275 patients with type 2 diabetes complicated by pulmonary infection admitted in Chongqing Fifth People′s Hospital from Apr. 2011 to Aug.2013 were divided into four groups according to random digital table.Patients in group A（69 cases） were treated with subcutaneous injection of insulin aspart 30 before meals;patients in group B were treated with subcutaneous injection of insulin aspart before meals joint with subcutaneous injection of insulin glargine before bedtime;patients in group C were treated with subcutaneous injection of human insulin R before meals and subcutaneous injection of human insulin N before bedtime;patients in group D were given continuous subcutaneous insulin pump injection .Patients in four groups were simultaneously given antibiotics therapy based on susceptibility testing,and the therapeutic effects on pulmonary infections at the 3rd day of treatment were evaluated;fasting glucose levels and glucose levels 2 h after breakfast of patients in the four groups before treatment and 1 week after treatment were detected;and incidence of low blood glucose were observed.Results The effective rates of group A,B,C,D were 76.8%,94.1%,87.3% and 89.6%,the effective rates of group B was significantly better than group A （P〈0.05）.Before treatment,fasting blood glu-cose levels of group A,B,C,D were （10.9 ±2.4） mmol/L,（12.4 ±3.6） mmol/L,（11.1 ±3.3） mmol/L and （12.2 ±2.6） mmol/L,blood glucose levels 2 h after breakfast were （17.4 ±2.0） mmol/L,（16.5 ± 1.8） mmol/L,（16.3 ±3.5） mmol/L and （16.3 ±2.7） mmol/L,after one week of treatment,fasting blood glucose levels of four groups were （6.4 ±0.9） mmol/L,（5.2 ±2.0） mmol/L,（5.6 ±0.8） mmol/L and （5.1 ±1.1） mmol/L,blood glucose levels 2 h after breakfast were （8.3 ±1.4） mmol/L,（9.0 ±5.0） mmol/L, （10.0 ±3.8） mmol/L and （10.0 ±3.8） mmol/L,fasting blood glucose levels and blood glucose levels 2 h after meal were significantly lower than those before treatment （ P〈0.01 ） .Fasting blood glucose levels of group B,C,D were significantly lower than those of group A（P〈0.05）;After treatment,blood glucose levels 2 h after breakfast of the four groups had no statistically significant differences（P〉0.05）.There were no statisti-cally significant differences of the incidences of hypoglycemia among the four groups（P〉0.05）.Conclusion Subcutaneous injection of insulin aspart 30 before meals has poor effect on reducing fasting blood glucose level,that it should be avoided in clinical application .