改良胰岛素给药方案对重症急性胰腺炎血糖波动和预后的影响  

Effect of modified insulin administration regimen on blood glucose fluctuation and prognosis in severe acute pancreatitis

作　　者：王霆[1] 丁俊华[1] 姜岱山 李山峰[1] 蔡琦[1] 刘春[1] WANG Ting;DING Junhua;JIANG Daishan;LI Shanfeng;CAI Qi;LIU Chun(Department of Emergency Medicine,the Affiliated Hospital of Nantong University,Nantong,Jiangsu,226001,China)

机构地区：[1]南通大学附属医院急诊医学科,江苏南通226001

出　　处：《临床急诊杂志》2020年第12期996-999,共4页Journal of Clinical Emergency

摘　　要：目的:探讨一种改良胰岛素给药方案对重症急性胰腺炎(SAP)患者血糖波动和预后的影响。方法:选择南通大学附属医院急诊重症监护室(EICU)收治的32例SAP患者为研究对象,随机分为试验组和对照组,对照组采用常规胰岛素(RI)给药方案;试验组采用改良方案,即根据单位时间内摄入葡萄糖量,按照葡萄糖4 g∶胰岛素1 U同步给予RI。每2 h测末梢血糖,记录、计算并比较两组患者入院初始血糖(BGad)、72 h平均血糖(BGm)和标准差(BGsd)、血糖变异系数(BGcv)、血糖不稳定指数(BGI)和低血糖发生率。比较两组患者入院时和入院72 h后白细胞计数(WBC)、超敏C反应蛋白(CRP)、降钙素原(PCT)的水平。记录并比较两组患者28 d病死率。结果:两组患者BGad、BGm、WBC、CRP、PCT无显著差异(P>0.05)。试验组患者72 h的BGsd、BGcv、BGI小于对照组(P<0.05),低血糖发生率与对照组差异无统计学意义(P>0.05)。试验组患者入院72 h后CRP和PCT较对照组有改善(P<0.05)。两组患者28天死亡率差异无统计学意义(P>0.05)。结论:对于SAP患者,改良胰岛素给药方案可以减少血糖波动,减轻炎症反应,但目前证据不足以支持改善28 d病死率。Objective: To investigate the effect of modified insulin administration regimen on blood glucose fluctuation and prognosis in patients with severe acute pancreatitis(SAP). Methods: A total of 32 SAP patients admitted to the emergency intensive care unit(EICU) were randomly divided into the experimental group and the control group. The control group was given conventional insulin administration, and the experimental group was given the modified scheme--according to the amount of glucose intake per unit time, insulin was given in the proportion of glucose 4 g: insulin 1 U at the same time. The peripheral blood glucose was measured every 2 hours. The initial blood glucose(BGad), 72 h mean blood glucose(BGm), standard deviation(BGsd), coefficient of blood glucose variability(BGcv), blood glucose instability index(BGI) and hypoglycemia incidence were recorded, calculated and compared between the two groups. The levels of white blood cell count(WBC), high sensitivity C-reactive protein(CRP) and procalcitonin(PCT) were compared between the two groups at admission and 72 hours after admission. The 28 d mortality was recorded and compared between the two groups. Results: There was no significant difference in BGad, BGm, WBC, CRP and PCT between the two groups(P>0.05). The BGsd, BGcv and BGI of the experimental group were lower than those of the control group(P<0.05), and the incidence of hypoglycemia was not significantly different from that of the control group(P>0.05). The CRP and PCT of the experimental group were better than those of the control group at 72 hours after admission(P<0.05). There was no significant difference in 28 day mortality between the two groups(P>0.05). Conclusion: For SAP patients, the modified insulin administration can reduce blood glucose fluctuation and inflammatory response, but the current evidence is not enough to support the improvement of 28 day mortality.

关 键 词：改良胰岛素给药方案 急性重症胰腺炎 血糖变异系数 血糖不稳定指数 

分 类 号：R576[医药卫生—消化系统]