门冬胰岛素与人普通胰岛素及胰岛素泵在2型糖尿病患者围手术期的疗效比较

目的：探讨速效胰岛素类似物（门冬胰岛素，诺和锐）与人普通胰岛素（诺和灵R）及胰岛素泵在2型糖尿病（T2DM）围手术期治疗中的有效性和安全性。方法：158例围手术期T2DM患者随机分为胰岛素泵输注门冬胰岛素治疗CSII组52例，门冬胰岛素多次皮下注射治疗MSII（A）组56例，人普通胰岛素多次皮下注射治疗MSII（B）组50例。观察各组患者治疗前后空腹和餐后2h血糖变化、血糖迭标时间、胰岛素用量、低血糖发生率及术后并发症发生率。结果：3组治疗后血糖均明显低于抬疗前，CSII组治疗后血糖低于MSII（A）组（P〈o．05），MSII（A）组治疗后血糖低于MSII（B）组（P〈0．05）；术后并发症CSII组低于MSII（A）组（P〈0．05），MSII㈧组低于MSII（B）组（P〈0．05）。结论：门冬胰岛素对T2DM围手术期血糖控制有较好的有效性、安全性和顺应性，胰岛素泵是2型糖尿病患者围手术期胰岛素输注的最佳模式。

Comparison Between Infusion Use Of Insulin Aspart and Novolin R during Perioperative Period of Patients with Type2 Diabetes Mellitus

Objective： To compare the efficacy and safety of rapid-acting human insulin analogue （Aspart） and regular human insulin （Novolin R） delivered with continuous subcutaneous insulin infusion （CSII） pump and multiple subcutaneous insulin infusion （MSI1） on perioperative period of patients with type 2 diabetes mellitus. Methods： 158 perioperative patients with poorly-controlled type 2 diabetes in hospital were randomized to Group CsII （n=52, treated with insulin Aspart）, Group MSII（A） （n=56, treated with insulin Aspart） and Group MSII（B） （n=50 ,treated with insulin Novolin R）. All patients were treated to achieve target glyeaemic control. The blood gincose, the time and the dose of insulin needed for good glycaemia control were compared of the three groups, the complications of surgery and incidence of hypoglycemia were evaluated too. Results： The levels of blood glucose in all groups were reduced after the treatments. The time for good glyeaemia control was shorter in Group CSII than that in Group MSII（A） and Group MSII（B） （P〈0.05）. The mean of the postprandial blood glucose was significantly lower in Group CSII than that in Group MSII（A） and Group MSH（B） （P〈0.01）. The complications of surgery and incidence of hypoglycemia were significantly lower in Group CSII than that in Group MSII（A） and Group MSII （B） （P〈0.05）. Conclusion： For the perioperative period of patients with type 2 diabetes mellitus, insulin Aspart provides a more effective and safety control of blood glucose, it can control the hyperglycemia rapidly with lower fluctuations of blood glucose than Novolin R. The insulin pump could be the best mode of insulin infusion for perioperative type 2 diabetes.