实时胰岛素泵在妊娠期糖尿病患者围手术期中的应用  

Application of sensor-augmented insulin-pump during perioperative period in patients with gestational diabetes mellitus

作　　者：沈艳军[1] 田亚强[1] 毕会民[2] 李明[1] 孙洁[1] 段洪刚[1] 申爱方[1] 

机构地区：[1]山东聊城市人民医院内分泌科,252000 [2]武汉大学人民医院内分泌科

出　　处：《中华糖尿病杂志》2015年第10期619-623,共5页CHINESE JOURNAL OF DIABETES MELLITUS

摘　　要：目的评价实时胰岛素泵系统在妊娠糖尿病（GDM）剖宫产围手术期的临床疗效。方法2012年4月至2013年12月选取具有剖宫产术指征的GDM患者，根据随机数字表法分为对照组（单C组）和试验组（3c组），单C组根据床边血糖监测结果调整胰岛素泵输注量，3C组根据动态血糖监测结果调整胰岛素泵输注量。比较两组患者围手术期血糖控制情况、胰岛素用量、低血糖发生率、切口愈合时间及新生儿不良结局。手术当天相关指标采用协方差分析，术后相关指标采用描述性分析。结果（1）共56例患者入组，单C组30例，3C组26例，两组患者基线资料相似，术前血糖控制无明显差异；（2）手术当天3C治疗组根据RT-CGMS调整基础率次数较多，基础胰岛素用量明显少于单C组[（O．31±0．09）比（0．38＋0．11）U／kg]，差异有统计学意义（t=2．62，P=0．03）；基础率调整次数多于单C组（56比22次），低血糖次数及低血糖发生率均少于单C组（5比15次、15．4％比30％，χ2=4．60、2．61，均P〈0．05）；（3）分娩后两组患者胰岛素需要量明显减少，其中3C组14人，单C组11人停用胰岛素；（4）术后切口愈合时间及新生儿不良结局两组差异无统计学意义。结论实时胰岛素泵系统在GDM围手术期的血糖管理中具有安全、快速、有效地控制血糖的独特优势。Objective To assess the efficacy of sensor-augmented insulin-pump （SAP） during the perioperative period of cesarean delivery in patients with gestational diabetes mellitus（GDM）. Methods GDM patients with indications of cesarean section were randomized into experimental group and control group according to table of random number between April 2012 to December 2013. The experimental group was treated with continuous subcutaneous insulin infusion （CSII） titrated based on real-time continuous glucose monitoring system （RT-CGMS）, while the control group was treated with CSII adjusted by point of care testing （POCT）. The level of blood glucose, insulin dosage, incidence of hypoglycemia, incision healing time and neonatal adverse outcomes were compared between two groups. Covariance analysis was used for the related indicators at the day of surgery, and descriptive analysis was used for the analysis of the postoperative related indicators. Results （1） A total of 56 patients were enrolled, 30 in control group and 26 in experimental group. Baseline characteristics of the patients were comparable between two groups. （2） On the day of surgery, basal rate was adjusted more frequently in experimental group according to RT- CGMS. The dose of basal insulin in the experimental group was significantly lower than in the control group （（0.31±0.09）vs （0.38 ±0.11） U/kg, t=2.62, P=0.03）. The frequency of basal rate adjustment was more in the experimental group （56 vs 22, P〈0.01）. The frequency and incidence of hypoglycemia were lower in the experimental group than in the control group （5 vs 15, 15.4% vs 30%, χ2=4.60, 2.61, both P〈0.05）. （3） The 24 h insulin dose decreased significantly after childbirth in both groups. Insulin use was ceased in 14 patients of experimental group and 11 of control group. （4） No significant difference were observed in incision healing time and neonatal adverse outcomes between the two groups. Conclusion Sensor-augmented insulin-pump demonstrat

关 键 词：糖尿病 妊娠 实时动态血糖监测 围手术期 

分 类 号：R714.256[医药卫生—妇产科学]