不同胰岛素注射方式治疗非昏迷高血糖危象患者的疗效研究  

Non-comatose Hyperglycemic Crisis:Low-dose Insulin Therapy by Two Routes

作　　者：赖伟华 罗思婵 陈广树 韩敦正[4] 汤穆浛 LAI Weihua;LUO Sichan;CHEN Guangshu;HAN Dunzheng;TANG Muhan(Department of Emergency,Guangzhou Red Cross Hospital,Guangzhou 510220,China;Haizhu District Hospital of Traditional Chinese Medicine,Guangzhou 510220,China;Department of Endocrinology,Guangzhou Red Cross Hospital,Guangzhou 510220,China;Department of Cardiology,the First Affiliated Hospital of Guangzhou Medical University,Guangzhou 510120,China)

机构地区：[1]广东省广州市红十字会医院急诊科,510220 [2]广东省广州市海珠区中医医院,510220 [3]广东省广州市红十字会医院内分泌科,510220 [4]广州医科大学附属第一医院心内科,广东广州510120

出　　处：《中国全科医学》2022年第6期719-723,共5页Chinese General Practice

基　　金：广东省医学科学技术研究基金资助(A2020178)。

摘　　要：背景高血糖危象是糖尿病的急危重症,治疗上体现个体化,降糖使用的胰岛素为小剂量静脉滴注,但相关研究指出全程使用胰岛素皮下注射泵同样能起到小剂量胰岛素静脉注射泵的效果,且使用更加简易方便。目的探讨治疗非昏迷高血糖危象患者时使用小剂量胰岛素静脉注射泵及胰岛素皮下注射泵的血糖缓解情况。方法选取2017年3月至2020年3月于广州市红十字会医院住院治疗的高血糖危象患者115例,其中糖尿病酮症酸中毒(DKA)72例,高渗高血糖综合征(HHS)43例。采用随机数字表法将患者分为小剂量胰岛素静脉注射泵组(n=58)及胰岛素皮下注射泵组(n=57)。小剂量胰岛素静脉注射泵组使用重组人胰岛素,胰岛素皮下注射泵组使用门冬胰岛素,患者血糖达标前,两组胰岛素用量均为0.10~0.15 U·kg^(-1)·h^(-1)。观察两组患者血糖下降速度、血糖达标时间、平均血糖及低血糖发生次数。结果小剂量胰岛素静脉注射泵组和胰岛素皮下注射泵组血糖下降速度、血糖达标时间、平均血糖、低血糖发生次数比较,差异均无统计学意义(P>0.05)。小剂量胰岛素静脉注射泵组和胰岛素皮下注射泵组中的DKA患者血糖下降速度、血糖达标时间、平均血糖、低血糖发生次数比较,差异均无统计学意义(P>0.05)。小剂量胰岛素静脉注射泵组和胰岛素皮下注射泵组中的HHS患者血糖下降速度、血糖达标时间、平均血糖、低血糖发生次数比较,差异均无统计学意义(P>0.05)。结论对于非昏迷高血糖危象患者,使用小剂量胰岛素静脉注射泵及胰岛素皮下注射泵均可有效缓解血糖,胰岛素皮下注射泵可作为高血糖危象患者降糖的注射方式之一。Background Hyperglycemic crisis is a critical emergency related to uncontrolled diabetes,and the treatment of which is individualized.Studies have showed that low-dose subcutaneous and insulin infusion with a pump have similar hypoglycemic effects in hyperglycemic crisis,but the former is simpler and more convenient.Objective To explore hypoglycemic effectsof low-dose subcutaneous versus insulin infusion with a pumpin the treatment of non-comatose hyperglycemic crisis.Methods One hundred and fifteen hyperglycemic crisis inpatients〔72 with diabetic ketoacidosis(DKA),and 43 with hyperosmolar hyperglycemic syndrome(HHS)〕were selected from Guangzhou Red Cross Hospital from March 2017 to March 2020,and divided into low-dose subcutaneous insulin infusion with a pump(n=58)and low-dose intravenous insulin infusion with a pump(n=57)using random number table,treated with recombinant human insulin,and insulin aspart,respectively.Both groups were treated by a continuous low-dose insulin infusion of 0.10-0.15 U·kg^(-1)·h^(-1) before meeting the glycemic targets.The speed of blood glucose reduction,time to reach the glycemic targets,average blood glucose and frequency of hypoglycemia were observed in both groups.Results The speed of blood glucose reduction,time to reach the glycemic targets,average blood glucose and frequency of hypoglycemia demonstrated no significant differences in both groups(P>0.05).These four indicators also showed no notable differences in DKA patients in both groups(P>0.05).Furthermore,theyhad no obvious differences in HHS patients in both groups(P>0.05).Conclusion In patients with non-comatose hyperglycemic crisis,eitherlow-dose subcutaneous or insulin infusion with a pump could effectively lower the blood glucose,and the former could be used as an alternative for hyperglycemic crisis.

关 键 词：高血糖危象 非昏迷 胰岛素注射方式 血糖 静脉注射 注射 皮下 

分 类 号：R587.2[医药卫生—内分泌]