微量白蛋白尿期2型DKA患者使用胰岛素泵治疗的疗效观察与分析

Observation and Analysis of the Effect of Insulin Pump Therapy on Patients of Type 2 Diabetic Ketoacidosis with Microalbuminuria

为观察胰岛素泵治疗微量白蛋白尿期2型糖尿病老年患者酮症酸中毒的临床疗效，本研究选取本院肾病风湿病科和内分泌科52例微量白蛋白尿期（30mg≤24h尿微量白蛋8〈300mg）2型糖尿病酮症酸中毒老年患者作为研究对象，入院时间从2015年6月至2017年1月。入院后所有纳入患者均给予快速补液、纠正水、电解质和酸碱平衡、调节血糖等处理。其中26例患者给予24h持续泵入诺和灵R的胰岛素泵治疗，初始设定胰岛素量为0．1U·kg^-1·h^-1。待酮体阴性、动脉pH正常时，给予基础量泵入，设为胰岛素泵组；另26例患者给予诺和灵R持续快速静滴，滴速为0．1U·kg^-1·h^-1，待酮体阴性、动脉pH正常时改为皮下注射的方式，设为持续静滴组。对比两组患者的尿酮体转阴时间、胰岛素用量以及低血糖发生率，本研究发现，两组患者在性别构成、年龄、糖尿病病程、尿微量白蛋白、发病次数和严重程度方面差异无统计学意义（p〉0．05）。胰岛素泵组尿酮体转阴时间要比持续静滴组短，胰岛素用量少，低血糖发生率低，两者差异具有统计学意义（p〈0．05）。由此可见，胰岛素泵可以明显减少微量白蛋白尿期2型糖尿病酮症酸中毒老年患者的胰岛素用量，缩短尿酮体转阴时间，同时减少低血糖发生风险。

In order to observe the clinical efficacy of insulin pump in the treatment of ketoacidosis in elderly patients with type 2 diabetes mellitus, 52 cases of elderly patients, who with type 2 diabetic ketoacidosis in microalbuminuria （30 mg ≤ 24 h urinary microalbumin 〈300 mg） from our hospital, were selected from department ofnephrology and endocrinology as research objects. The admission time was from June 2015 to January 2017. All patients enrolled after admission were given rapid fluid replacement, correction of water, electrolyte and acid-base balance, and regulation of blood glucose. 26 patients were given 24-hour continuous insulin pump treatment with Novool R. The initial set insulin amount was 0.1 U·kg^-1 ·h^-1. When the ketone body was negative and the arterial pH was normal, the basal amount was pumped, they were set as insulin pump group. Another 26 patients were given Novoline R for rapid intravenous infusion. The dropping rate was 0.1 U·kg^-1 ·h^-1. When the ketone body was negative and the arterial pH was normal, it was changed to subcutaneous injection and set them as the continuous intravenous group. This study compared the urinary ketone body time, insulin dosage, and hypoglycemia rates in the two groups. The result showed that there was no significant difference in gender composition, age, duration of diabetes, microalbuminuria, incidence and severity between the two groups （p〉0.05）. In the insulin pump group, the time of urinary ketone conversion was shorter than the continuous intravenous group, the insulin dosage, and the hypoglycemia rate were also lower. The difference was statistically significant （p〈0.05）. It could be seen that the insulin pump could significantly reduce the insulin dosage in elderly patients with type 2 diabetic ketoacidosis in microalbuminuria, shorten the time of urinary ketone conversion, and reduce the risk of hypoglycemia.