摘要
目的探讨糖尿病酮症酸中毒(diabetic ketoacidosis,DKA)患者胰岛素微量泵泵注的起始剂量,及其对1h后血糖下降值(decreased blood glucose value after 1h,△1hBG)有效率的影响。方法 DKA患者82例,其中1型糖尿病(type 1diabetes mellitus,T1DM)患者26例(T1DM组),2型糖尿病(type 2diabetes mellitus,T2DM)患者56例(T2DM组),均给予微量泵泵注胰岛素治疗;依据第1小时胰岛素起始剂量中位数,将82例患者分为高泵速组、低泵速组;胰岛素治疗7-10d后,测定T2DM组患者空腹C肽、餐后2hC肽水平,依据空腹C肽与餐后2hC肽之和的中位数,将T2DM组患者分为2组;比较各组一般资料及入院时血糖、胰岛素起始剂量、△1hBG及其有效率。结果胰岛素起始剂量中位数为0.043 478u/(kg·h);起始剂量≥0.043 478u/(kg·h)41例为高泵速组,〈0.043 478u/(kg·h)41例为低泵速组,2组年龄、性别比例、体质量指数、病程比较差异均无统计学意义(P〉0.05);高泵速组初始血糖[(29.48±7.92)mmol/L]、胰岛素起始剂量[(0.068±0.019)u/(kg·h)]、△1hBG[(3.57±1.99)mmol/L]高于低泵速组[(19.73±5.25)mmol/L、(0.029±0.012)u/(kg·h)、(2.27±1.49)mmol/L](P〈0.05);高泵速组△1hBG有效率(65.9%)与低泵速组(46.3%)比较差异无统计学意义(P〉0.05);T2DM组空腹C肽与餐后2hC肽之和中位数为0.267nmol/L,C肽≥0.267nmol/L 28例为高C肽组,C肽〈0.267nmol/L 28例为低C肽组,高、低C肽组年龄较T1DM组大,病程较T1DM组长(P〈0.05);高C肽组年龄较低C肽组小,病程较低C肽组短(P〈0.05),体质量指数高于低C肽组和T1DM组(P〈0.05);T1DM组、高C肽组、低C肽组初始血糖、胰岛素起始剂量比较差异无统计学意义(P〉0.05),但高C肽组△1hBG[(2.35±1.86)mmol/L]低于低C肽组[(3.58±2.07)mmol/L](P〈0.05);TIDM组、高C肽组、低C肽组△1hBG有效率分别为50.0%、46.4%、71.4%,3组比较差异无统计学意义(P〉0.05);但3组△1hBG〉4.2mmol/L比率(26.9%、17.9%、57.1%)比较差异有统计学意义,且低C肽组高于高C肽组(P〈0.05)。结论胰岛素泵注起始剂量0.05u/(kg·h)可有效降低成人DKA患者血糖水平,临床可结合患者血糖、年龄、病程、体质量指数进一步调整胰岛素泵注剂量。
Objective To explore the initial dose of insulin through micro-pump infusion in the patients with diabetic ketoacidosis,and its influence on the efficiency of decreased blood glucose value after 1h(△1hBG).Methods Eightytwo patients with diabetic ketoacidosis included 26 cases of type 1diabetes mellitus(T1DM group)and 56 cases of type 2diabetes mellitus(T2DM group).All patients were treated with micro-pump infusion of insulin.According to the median insulin initial dose,82 patients were divided into high pumping speed group(HP group)and low pumping speed group(LP group).After 7-to 10-day treatment,fasting C-peptide and 2-hour postprandial C-peptide were detected,and according to the median sum of fasting C-peptide and 2-hour postprandial C-peptide,T2 DM group was divided into two subgroups(high C-peptide group and low C-peptide group).The general clinical data,blood glucose at admission,insulin initial dose,△1hBG,and efficiency of△1hBG were compared among groups.Results According to the median insulin initial dose 〈 0.043 478u/(kg·h),41 patients with insulin initial dose≥0.043 478u/(kg·h)were as HP group,and the left 41 patients with insulin initial dose0.043 478u/(kg·h)were as LP group.There were no significant differences in the age,gender ratio,body mass index and disease course between two groups(P〉0.05).The levels of blood glucose at admission((29.48±7.92)mmol/L),insulin initial dose((0.068±0.019)u/(kg·h)),△1hBG((3.57±1.99)mmol/L)in HP group were significantly higher than those in LP group((19.73±5.25)mmol/L,(0.029±0.012)u/(kg·h),(2.27±1.49)mmol/L)(P〈0.05).There was no significant difference in the efficiency of△1hBG between HP group(65.9%)and LP group(46.3%)(P〉0.05).According to the median sum of fastingC-peptide and 2-hour postprandial C-peptide of 0.267nmol/L,28 patients with the median sum ≥0.267nmol/L were as C-peptide group,and the left 28 patients with the median sum 〈0.267nmol/L were as low C-peptide group.The patients were older and the disease course was significantly longer in both high and low C-peptide groups than those in T1 DM group(P〈0.05).The patients were significantly younger and disease course was significantly shorter in high Cpeptide group than those in low C-peptide group(P〈0.05).BMI was significantly lower in high C-peptide group than that in low C-peptide group and T1 DM group(P〈0.05).There were no significant differences in blood glucose at admission and insulin initial dose among T1 DM group,high C-peptide group and low C-peptide group(P〈0.05).The level of△1hBG((2.35±1.86)mmol/L)in high C-peptide group was significantly lower than that in low C-peptide group((3.58±2.07)mmol/L)(P〈0.05).The efficiency of△1hBG was 50.0%,46.4% and 71.4%in T1 DM,high C-peptide and low C-peptide groups,respectively,showing no significant difference among three groups(P〉0.05).The patients with △1hBG〉4.2mmol/L accounted for 26.9%,17.9% and 57.1% in T1 DM,high C-peptide and low Cpeptide groups,respectively,and was significantly higher in low C-peptide group than that in high C-peptide group(P〈0.05).Conclusion The insulin initial dose of 0.05u/(kg·h)through micro-pump infusion can effectively decrease the blood glucose level in adult patients with diabetic ketoacidosis.The dose should also be adjusted with the blood glucose level,age,disease course and BMI.
出处
《中华实用诊断与治疗杂志》
2016年第12期1238-1241,共4页
Journal of Chinese Practical Diagnosis and Therapy
基金
国家自然基金面上项目(2011YD81170764)