骨折合并2型糖尿病患者围术期胰岛素类似物持续皮下输注与每日多次皮下注射的疗效和安全性比较  

Efficacy and safety comparison of continuous subcutaneous insulin analogues infusion and multiple daily insulin analogues injection in fracture patients with type 2 diabetes mellitus during the perioperative period

作　　者：李伟[1] 李全志[2] 李泉 王志新[1] 徐晓杰 王茹 邓微[1] Li Wei;Li Quanzhi;Li Quan;Wang Zhixin;Xu Xiaojie;Wang Ru;Deng Wei(Department of Endocrinology,Beijing Jishuitan Hospital,Beijing 100035,China;Department of Pharmacy,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院内分泌科,北京100035 [2]北京积水潭医院药剂科,北京100035

出　　处：《药物不良反应杂志》2022年第11期578-583,共6页Adverse Drug Reactions Journal

摘　　要：目的比较骨折合并2型糖尿病患者围术期持续皮下胰岛素输注(CSII)与每日多次胰岛素注射(MDII)的疗效及安全性。方法通过医院信息系统收集北京积水潭医院2017至2021年收治的下肢骨折合并2型糖尿病患者的病历资料进行回顾性分析,提取的临床资料包括患者性别、年龄、体重、体重指数、骨折部位、疼痛评分及分级、骨折距入院时间、2型糖尿病病程、入院实验室检查结果、入院后血糖控制方案和监测情况以及不良事件发生情况。根据患者围术期血糖控制方案分为CSII组和MDII组,比较2组患者临床特征、血糖达标时间、胰岛素使用情况和不良事件发生情况。结果共有207例患者纳入分析,男性90例,女性117例;年龄(61±15)岁;体重指数(25.5±3.5)kg/m2;CSII组102例,MDII组105例。2组患者在性别,年龄,体重指数,骨折部位,疼痛评分及分级,骨折距入院时间,2型糖尿病病程,入院实验室检查结果等方面的差异均无统计学意义(均P>0.05)。CSII组患者空腹血糖达标时间、餐后2 h血糖达标时间以及2者同时达标时间均较MDII组短[(48.7±30.2)h比(78.7±44.5)h,P=0.003;(66.8±31.5)h比(93.3±47.6)h,P=0.001;(68.4±30.5)h比(96.3±48.1)h,P<0.001]。空腹和餐后2 h血糖同时达标时CSII组患者单位体重每日胰岛素总剂量和餐前总剂量均明显少于MDII组[(0.67±0.20)U/kg比(0.73±0.17)U/kg,P=0.030;(0.34±0.10)U/kg比(0.38±0.09)U/kg,P=0.004]。207例患者中,共17例患者发生23例次低血糖,发生率8.2%(17/207)。2组患者低血糖总体发生率差异无统计学意义[4.9%(5/102)比11.4%(12/105),P=0.319],CSII组5例低血糖患者无一例发生第2次低血糖,MDII组12例低血糖患者中4例发生2次、1例发生3次低血糖。发生的其他药物不良事件包括过敏、全身水肿、皮下脂肪结节性增生和注射部位持续出血。CSII组有8例患者发生其他不良事件,其中装置故障5例,麻醉期间佩戴胰岛素泵、佩戴�Objective To compare the efficacy and safety of continuous subcutaneous insulin analogues infusion(CSII)and multiple daily insulin analogues injection(MDII)in fracture patients with type 2 diabetes mellitus(T2MD)during the perioperative period.Methods The medical data of patients with lower limb fracture complicated with T2MD in Beijing Jishuitan Hospital from 2017 to 2021 were collected by hospital information system and analyzed retrospectively.The medical data of patients extracted included gender,age,body weight,body mass index(BMI),fracture site,pain score and grading,time from fracture to admission,duration of T2MD,laboratory test results at admission,blood glucose control regimen and monitoring result after admission,and the adverse events.Patients were divided into CSII group and MDII group according to blood glucose control regimen during the perioperative period.The clinical features,time to reach target blood glucose range,insulin application,and adverse events in patients of the 2 groups were compared.Results A total of 207 patients were enrolled in this study,including 90 males and 117 females,aged(61±15)years with BMI of(25.5±3.5)kg/m2.No significant differences were found in gender,age,BMI,fracture site,pain score and grading,time from fracture to admission,duration of T2MD,and labo⁃ratory test resurts at admission in patients between the 2 groups(all P>0.05).Patients in the CSII group had shorter time to reach target range of fasting blood glucose,2⁃h postprandial blood glucose,and the both than those in the MDII group[(48.7±30.2)h vs.(78.7±44.5)h,P=0.003;(66.8±31.5)h vs.(93.3±47.6)h,P=0.001;(68.4±30.5)h vs.(96.3±48.1)h,P<0.001].The total daily dose and total pre⁃prandial dose of insulin per unit weight in patients when the fasting and 2⁃h postprandial glucose both reach the target range were less in the CSII group than those in the MDII group[(0.67±0.20)U/kg vs.(0.73±0.17)U/kg,P=0.030;(0.34±0.10)U/kg vs.(0.38±0.09)U/kg,P=0.004].In 207 patients,hypoglycemia occurred in 17 patie

关 键 词：糖尿病 骨折 低血糖 围术期 注射 皮下 胰岛素持续皮下输注 

分 类 号：R969.3[医药卫生—药理学] R587.2[医药卫生—药学]