高血糖危象患者在停止静脉输注胰岛素向皮下注射胰岛素时转换方式的探讨

Study on the timing of intravenous insulin infusion switching to subcutaneous insulin injection in patients with hyperglycemia crisis

目的探讨高血糖危象患者静脉输注胰岛素向皮下注射速效胰岛素类似物的转换时机。方法将符合纳入和排除标准的使用微量泵持续静脉输注胰岛素降糖的糖尿病高血糖危象患者98例,采用随机数字表法分为实验组46例,在停止微量泵持续静脉输注胰岛素同时皮下注射速效胰岛素类似物;对照(Con)组52例,在停止微量泵持续静脉输注胰岛素前1h皮下注射速效胰岛素类似物,观察两组停泵前60、30min,停泵时,停泵后30、60、120min 6个时间点平均血糖值、血糖波动幅度。结果两组不同时间段血糖波动幅度比较,差异无统计学意义(P>0.05)。结论停止微量泵持续静脉输注胰岛素,同时皮下注射速效胰岛素类似物可实现静脉胰岛素向皮下注射转换的连续性和血清胰岛素相对恒定,值得临床推广应用。

Objective To investigate the timing to switch intravenous insulin infusion to subcutaneous injection of fast-acting insulin analogs in patients with hyperglycemia crisis. Methods 98 diabetic hyperglycemia crisis patients treated with micro pump continuous intravenous infusion of insulin were randomly divided into 2 groups. The experimental group（n--46） accepted subcutaneous injection of fast-acting insulin analogs while stopping continuous intravenous insulin infusion. The control group（n= 52） was subcutaneously injected with fast-acting insulin analogs 1 hour before cessation of intravenous insulin infusion. The average blood glucose and the fluctuation of blood glucose at 6 time points were observed, including 30 min and 60 min before stopping the pump, the right time stopping insulin pump, and 30 min, 60 min and 120 min after pump therapy. Results There were no significant differences between two groups in the fluctuation of blood glucose in different time points （P〉 0.05）. Conclusion Subcutaneous injection of fast-acting insulin analogs immediately after the intravenous insulin infusion can maintain the continuity and stability of hypoglycemic therapy, which is worthy of clinical application in patients with hyperglycemia crisis.