甘精胰岛素控制ICU老年2型糖尿病合并重症肺炎患者血糖的疗效观察  

Observation on the effect of insulin glargine on controlling blood glucose in ICU elderly patients with type 2 diabetes and severe pneumonia

作　　者：章江南[1] 赵曦乐[1] ZHANG Jiangnan;ZHAO Xile(Department of Endocrinology,Fuzhou First Hospital,Fuzhou350009,China)

机构地区：[1]福州市第一医院内分泌科,福建福州350009

出　　处：《中国现代医生》2020年第31期51-54,共4页China Modern Doctor

摘　　要：目的探讨甘精胰岛素对重症监护病房(ICU)老年2型糖尿病合并重症肺炎患者的血糖水平及临床预后的影响。方法将2015年10月~2017年10月收住于我院ICU的2型糖尿病合并重症肺炎患者46例随机分为甘精胰岛素治疗组(A组)23例和常规胰岛素治疗组(B组)23例。记录收住ICU时的初始血糖、糖化血红蛋白,统计入住ICU期间内平均血糖、血糖最大值,血糖标准差、血糖变异系数,记录血糖达标的时间、治疗后血糖水平、胰岛素总用量、入住ICU14 d内低血糖发生情况及28 d死亡率。结果两组患者入住ICU时的初始血糖(Glu Adm)[(16.70±3.72)mmol/L vs(15.30±4.10)mmol/L]、糖化血红蛋白水平[(10.00±1.08)%vs(9.78±2.08)%]比较,差异无统计学意义(P>0.05),治疗14 d后,A组血糖达标平均时间为(70.3±10.5)h,明显短于B组的(140.0±13.6)h,治疗后平均血糖水平A组为(5.1±1.6)mmol/L,明显低于B组的(6.8±2.1)mmol/L,差异有统计学意义(P<0.05);A组每天胰岛素总用量为(30.2±2.3)U/d,明显低于B组的(48.0±1.8)U/d,差异有统计学意义(P<0.05);A组出现低血糖发生率显著低于B组(4.35%vs 26.09%),差异有统计学意义(P<0.05);两组28 d的死亡率比较(21%vs 34%),差异无统计学意义(P>0.05)。结论以甘精胰岛素作为基础胰岛素治疗老年2型糖尿病合并重症肺炎的高血糖方案有效,同时与传统方法相比减少了血糖波动,降低低血糖发生率,在临床工作中值得推广应用。Objective To investigate the effect of insulin glargine on the blood glucose level and clinical prognosis of elderly patients with type 2 diabetes and severe pneumonia in the intensive care unit(ICU).Methods Forty-six patients with type 2 diabetes and severe pneumonia who were admitted to the ICU of our hospital from October 2015 to October 2017 were randomly divided into insulin glargine treatment group(group A,n=23)and conventional insulin treatment group(group B,n=23).The initial blood glucose and glycosylated hemoglobin when admitted to the ICU were recorded.The average blood glucose,maximum blood glucose,blood glucose standard deviation,and variation coefficient of blood glucose during admission to the ICU were counted.The time when blood glucose reaching the target,blood glucose level after treatment,total insulin dosage,the occurrence of hypoglycemia within 14 days of ICU admission and 28-day mortality were recorded.Results There was no significant difference in the initial blood glucose(Gluadm)([16.70±3.72]mmol/L vs[15.30±4.10]mmol/L)and glycosylated hemoglobin levels between the two groups[(10.00±1.08)%vs(9.78±2.08)%](P>0.05)After 14 days of treatment,the average time to reach the target blood glucose in group A was(70.3±10.5)h,which was significantly shorter than the average time of group B(140.0±13.6)h.After treatment,the average blood glucose level of group A was(5.1±1.6)mmol/L,which was significantly lower than that of group B(6.8±2.1)mmol/L,and the differences were statistically significant(P<0.05).The total daily insulin dosage of group A(30.2±2.3)U/d was significantly lower than that of group B[(48.0±1.8)U/d],and the difference was statistically significant(P<0.05).The incidence of hypoglycemia in group A was significantly lower than that of group B(4.35%vs 26.09%),and the difference was statistically significant(P<0.05).There was no significant difference in 28-day mortality between the two groups(21%vs 34%,P>0.05).Conclusion Insulin glargine is effective as a basic insulin to treat hyp

关 键 词：甘精胰岛素 普通胰岛素 ICU 老年2型糖尿病合并重症肺炎 血糖变异系数 

分 类 号：R587[医药卫生—内分泌]