不同胰岛素给药方式救治糖尿病酮症酸中毒临床研究

目的：比较不同胰岛素给药方式治疗糖尿病酮症酸中毒（DKA）的临床疗效。方法：82例DKA患者随机分为胰岛素泵持续皮下输液胰岛素（CSⅡ）组和微量泵持续静脉泵入胰岛素（CXqI）组各41例，分别给予胰岛素泵持续皮下输注胰岛素和小剂量胰岛素持续微量泵静脉泵入不同胰岛素给药方式，观察两组治疗后血糖变化、血糖达标时间、尿酮体变化、pH值变化、胰岛素平均日用量、平均低血糖次数及平均住院时间。结果：两组治疗后空腹血糖、餐后血糖显著下降及血糖达标时间显著缩短差异无统计学意义（P〉0．05）；CSII组尿酮体转阴时间（22．3±7．4）h短于CVII组（32．1±12．1）h（P〈0．01）；CSII组PH值恢复时间（9．4±2．5）h短于CVII组（15．7±3．5）h（P〈0．01）；CSII组平均胰岛素日用量为（47±5）U比CVII组（58＋7）U少（P〈0．01）；CSII组人均低血糖次数为（0．6±O．5）次／人。少于CVII组（1．5±0．8）次／人（P〈O．01）；CSII组住院时间（9．8±1．2）天明显比CVII组（12．5±2．0）天短（P〈0．01）。结论：CSII相较于CVII能更快更有效的纠正代谢紊乱，减少胰岛素日用量，缩短住院时间，从而提高临床疗效。具有较高的安全性及患者依从性。

Clinical Study of Different Insulin Infusion Methods in Treatment of Diabetic Ketoacidosis＊

Obj.＇rive： To evaluate the efficacy and safety of continuous subcutaneous insulin infusion （CSlI） and continuous intravenous insulin infusion （CVII） with regular human insulin in patients with diabetic ketoacidosis （DKA）. Mothods： 82 Diabetic ketoacidosis patients were randomized to receive either CSII by a portable insulin pump （n=41） or CVII （n--41）. Fasting and postprandial blood glucose levels after treatment, blood glucose target time, the urine acetone bodies＇ extinction time, the pH value＇s recovery time, the insulin＇s average doses a day, the incidence of hypoglycemia and the average stay were recorded and compared. Results： CSII group and CVII group were both effective in controlling blood glucose levels and shorting blood glucose target time,no statistical difference （P 〉 0.05）. The time to correct ketonuria was shorter in CSII group compared with CVII group （22.3± 7.4）h vs （32.1± 12.1 ）h （P±0.01）]. The pH value recovering time of CSII grouph was shorter than CVII group （9.4± 2.5）h vs（ 15.7± 3.5 ）h（P〈：0.01 ）]. Mean insulin doses were significantly lower with CSII than with CVII（47± 5）u vs（58± 7）u （P±0.01）]. The rate of hypoglycemia was reduced in CSI/ group（0.6± 0.5）vs（ 1.6± 0.5）（P±0.01 ）]. The mean average days of CSII group was not so many as CVII group（9.8± 1.2）d vs（12.5± 2.0）d （P±0.01 ]. Conclusions： Compared with CVII, CSII is effective in treating DKA. It can rapidly improve metabolic control and enable a better quality of life.