胰岛素泵和多次胰岛素皮下注射治疗老年危重症高血糖的有效性和安全性比较  

A comparison of efficacy and safety in the treatment of hyperglycemia with continuous subcutaneous insulin with insulin pump or multiple insulin injections daily in critical elderly patients

作　　者：黄武[1] 刘幼硕[1] 王艳姣[1] 龙利民[1] 李霞[1] 王翼[1] 杨宇[1] 

机构地区：[1]中南大学湘雅二医院老年病科,湖南长沙410011

出　　处：《中国危重病急救医学》2008年第9期546-549,共4页Chinese Critical Care Medicine

基　　金：湖南省医药卫生科研基金项目（000-41）;湖南省科技厅科研基金资助项目（2007-JT2009,2007-FJ4166）

摘　　要：目的比较持续皮下注射胰岛素（CSII，即胰岛素泵）和多次皮下注射胰岛素（MDI）强化治疗改善老年危重症高血糖的有效性和安全性。方法选择本院老年危重病患者94例，入组时空腹血糖为（10．3±2．5）mmol／L；随机分为CSII组（46例）和MDI组（48例），两组均注射可溶性人胰岛素，连续治疗7d，观察两组血糖控制情况、7d内日平均胰岛素用量、低血糖发生率，第7日血清C-反应蛋白（CRP）、肿瘤坏死因子-α（TNF—α）、白细胞介素-6（IL-6）水平、急性生理学与慢性健康状况评分系统Ⅱ（APAcHEⅡ）评分以及28d病死率。结果与MDI组比较，CSII组血糖控制更好，血糖控制良好率[76．1％（35／46）比33．3％（16／48）]及血糖控制尚可率更高[21．7％（10／46）比14．6％（7／48）]，而控制差的更低[2．2％（1／46）比52．1％（25／48）]；低血糖发生率更低[10．9％（5／46）比22．9％（11／48）]，7d内日平均胰岛素用量更少[（40．1±6．3）U／d比（46．2±7．1）U／d]；血清TNF—α[（11．5±2．7）μg／L比（19．8±4．2）μg／L]、IL-6水平[（78．3±5．1）μg／I．比（141．4±6．2）μg／L]、CRP水平[（53．1±3．3）mg／L比（72．1土4．0）mg／L]明显低于MDI组；APACHEⅡ评分明显低于MDI组[（6．0±1．4）分比（11．6±1．0）分]；CSII组28d病死率低于MDI组[4．3％（2／46）比16．7％（8／48）]；差异均有统计学意义（P均〈0．05）。结论胰岛素泵较多次皮下注射治疗可更好地控制危重症高血糖，减轻炎症反应及改善短期预后。Objective To compare efficacy and safety in the treatment of hyperglycemia with continuous subcutaneous insulin infusion （CSII） or multiple daily insulin injection （MDI） in critical elderly patients. Methods Ninety-four elderly patients in critical condition with fasting glucose （10.3 ± 2.5） mmol/L were randomly divided into CSII group （46 cases） and MDI group （48 cases）. Soluble human insulin was used in both groups, and the treatment lasted for 7 days, and blood glucose level, average insulin dosage, percentage of hypoglycemia during 7 days, blood C-reacting protein （CRP）, tumor necrosis faetor-α （TNF-α）, interleukin-6 （IL-6） level and acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ ） scores on the 7th day, and mortality during 28 days were observed. Results Compared with MDI group, blood glucose was better controlled [76.1% （35/46） vs. 33.3% （16/48）], percentage of fair control of blood glucose level was higher [21.7% （10/46） vs. 14.6% （7/48）], percentage of poor control of blood glucose level was lower [2.2% （1/46） vs. 52.1% （25/48）], percentage of hypoglycemia was lower [10.9% （5/46） vs. 22.9% （11/48）], average insulin dosage during 7 days was less [（40.1±6. 3） U/d vs. （46.2±7.1） U/d], serum TNF-α level [（11.5±2.7） μg/L vs. （19.8±4.2） μg/L], IL-6 level [（78.3± 5.1）μg/L vs. （141.4±6.2） μg/L] and CRP level [（53.1±3. 3） mg/L vs. （72.1±4.0） mg/L] on the 7th day was lower, APACHE Ⅱ score was lower on the 7th day [（6.0±1.4） scores vs. （11.6±1.0） scores], and 28-day mortality was lower in CSII group [4.3% （2/46） vs. 16.7% （8/48）]. All the above values showed statistically significant difference between two groups （all P〈0.05）. Conclusion CSII can better control blood glucose and alleviate inflammatory response and improve prognosis in elderly critically ill patients.

关 键 词：危重病 胰岛素泵 糖尿病 应激 老年 

分 类 号：R686[医药卫生—骨科学]