微量泵泵注胰岛素治疗糖尿病酮症酸中毒起始剂量分析

Initial dose of insulin through micropump infusion in the treatment of diabetic ketoacidosis

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.