胰岛素不同给药途径对CAPD患者腹膜炎发生率的影响  

Effect of Different Insulin Injection Ways on Incidence of Continuous Ambulatory Peritoneal Dialysis(CAPD) Associated Peritonitis

作　　者：廖玉梅[1] 王青[1] 熊子波[1] 高敏[1] 徐春华[1] 

机构地区：[1]北京大学深圳医院肾内科,广东深圳518036

出　　处：《护理学杂志》2009年第15期8-10,共3页

基　　金：深圳市医疗卫生系统2005年科技计划非资助项目(深科信[2005]227号)

摘　　要：目的探讨终末期糖尿病肾病患者腹膜透析时胰岛素不同给药途径对腹膜炎发生率的影响,为合理使用胰岛素、减少腹膜炎发生率提供临床依据。方法将47例终末期糖尿病肾病行持续非卧床腹膜透析(CAPD)患者随机分为腹腔组(23例)和皮下组(24例),腹腔组行腹腔给药(胰岛素加入腹膜透析液中行CAPD治疗),皮下组予皮下注射胰岛素。比较两组患者腹膜炎发生率并分析其发生原因,胰岛素用量、费用,低血糖事件发生率及血糖控制水平。结果两组患者腹膜炎发生率、血糖控制水平、低血糖事件发生率比较,差异无统计学意义(均P>0.05);腹腔应用胰岛素剂量是皮下注射胰岛素剂量的2倍,但腹腔给药比皮下注射费用低4.73倍。发生腹膜炎的原因主要为已培训人员操作不规范及更换未经正规培训的人员操作。结论在规范培训、严格考核、定期追踪随访CAPD患者的情况下,胰岛素腹腔内给药不会增加腹膜炎的发生率,且可减少费用,减轻患者痛苦,为CAPD治疗依从性较好的患者提供了控制血糖的新途径。Objective To explore the effect of different insulin iniection ways on incidence of continuous ambulatory peritoneal dlalysts （CAPD） associated peritonitis in patients with end stage diabetic nephropathy. Methods A total of 47 patients were divided into an intraperitoneal group （n = 23） and a subcutaneous group （n = 24）. In the intraperitoneal group, insulin was added into dialysis fluid during CAPD, while in the subcutaneous group, insulin was injected subcutaneously. The rates of peritonitis and hypoglycemia, the dosage of insulin, the cost and the levels of blood glucose were compared between the two groups. Results There were no significant differences in the rates of peritonitis and hypoglycemia, and in the levels of blood glucose between the two groups （P〉0.05 for all）. The dosage of insulin in the intraperitoneal group was twice as much as that in the subcutaneous group, but the cost in the intraperitoneal group was 4.73 times lower than that in the subcutaneous group. The cause of CAPD-associated infection lay in inappropriate medical procedures and untrained caregivers. Conclusion The method of intraperitoneal insulin infusion would not increase the rates of peritonitis; it also decreases the medical expense and is an effective treatment for CAPD patients under the regular medical procedure.

关 键 词：糖尿病肾病 腹膜透析 胰岛素 腹膜炎 皮下注射 腹腔注射 

分 类 号：R473.5[医药卫生—护理学]