皮下持续输注胰岛素在患者全胰切除术后血糖管理中的应用

Application of subcutaneous infusion unremittingly of insulin in glucose management of patients underwent total pancreatectomy

目的探讨皮下持续输注胰岛素在全胰切除术后患者血糖管理中的有效性和安全性,并总结基础率设定规律。方法 2012年1月至2017年1月于北京协和医院行全胰切除术患者4例(男性1例,女性3例),年龄48~74岁。术后使用皮下持续输注胰岛素,按照6段法设置皮下持续输注胰岛素基础率,总结患者全天平均血糖、全天血糖变异系数及全天胰岛素使用剂量。结果患者全天平均血糖中位数为8.7 mmol/L,全天血糖变异系数中位数为0.21。第1例和第4例患者在皮下持续输注胰岛素期间曾有凌晨及夜间低血糖,未见严重低血糖。全天胰岛素总量中位数为0.27 IU/kg。患者基础率设置规律:0~4为0~0.9X,4~9为0~1.0X,9~12为1.2~1.8X,12~17为1.2~1.8X,17~21为0.8~2.2X,21~24为0~0.8X(X为全天平均基础率),患者日间平均基础率中位数为0.48 IU/h,夜间平均基础率中位数为0.21 IU/h。结论全胰切除术后患者使用皮下持续输注胰岛素血糖波动小,全天胰岛素用量少,夜间胰岛素基础率设定应远小于日间基础率。

Objective To investigate the effectiveness and safety of subcutaneous infusion unremittingly of insulin in the glucose administration of patients underwent total pancreatectomy and sum up the basal rate setting range.Methods We enrolled in 4 patients underwent total pancreatectomy（ 1 male,3 females）,48-74 years old,treated with subcutaneous infusion unremittingly of insulin and set basal rate in accordance with six paragraph method after pancreatectomy in Peking Union Medical College Hospital from January 2012 to January 2017, and summarized the average of the whole day glucose,the coefficient of variation of the whole day glucose and the daily dose of insulin. Results The median of average of the whole day glucose of patients was 8. 70 mmol/L. The median of coefficient of variation of the whole day glucose of patients was 0. 21. Patient 1 and patient 4 had hypoglycemia at night or fasting during the use of artificial pancreas,no severe hypoglycemia was observed. The median of daily dose of insulin of patients was 0. 27 IU/kg. The basal rate setting range was 0 ~ 4： 0 ~ 0. 9 X,4 ~ 9： 0 ~ 1. 0 X,9 ~ 12：1. 2 ~ 1. 8 X,12 ~ 17： 1. 2 ~ 1. 8 X,17 ~ 21： 0. 8 ~ 2. 2 X,21 ~ 24： 0 ~ 0. 8 X（ X was average basal rate）. The median of average based dosage during the day and the night was 0. 48 IU/h and 0. 21 IU/h,respectively. Conclusions Application of subcutaneous infusion unremittingly of insulin can significantly reduce glucose fluctuations and the amount of insulin throughout the day,the based dosage in night should be set far less than the based dosage of full day in patients underwent total pancreatectomy.