胰岛素一次性冲击治疗糖尿病酮症酸中毒患者的疗效和安全性分析  

Efficacy and safety of one-time insulin shock therapy on patients with diabetic ketoacidosis

作　　者：廖宴 刘博语 黄文龙 戴娟 徐贵森 LIAO Yan;LIU Bo-yu;HUANG Wen-long;DAI Juan;XU Gui-sen(Department of Emergency Medicine,General Hospital of Western Warfare Zone,Chengdu 610081,Sichuan,China)

机构地区：[1]西部战区总医院急诊医学科,四川成都610081

出　　处：《川北医学院学报》2023年第4期534-537,共4页Journal of North Sichuan Medical College

摘　　要：目的:探究胰岛素一次性冲击治疗方案对糖尿病酮症酸中毒(DKA)患者疗效及其对血清血酮、肌酸激酶(CK)、乳酸值水平的影响。方法:选取124例DKA患者作为研究对象,根据患者胰岛素静注方案不同分为观察组(n=62)和对照组(n=62)。对照组患者给予小剂量胰岛素持续静脉滴注;观察组患者先给予胰岛素一次性冲击治疗,之后使用与对照组患者相同治疗方案进行治疗。比较两组患者临床指标(血糖达标时间、病情缓解时间、血pH值恢复时间)及治疗前后酸中毒相关指标[血β-羟丁酸(β-HB)、血乳酸(Lac)、血酮体]、血糖指标[空腹血糖(FPG)、餐后2 h血糖(2hPG)、糖化血红蛋白(HbA1c)]、心肌酶谱[CK、肌酸激酶同工酶(CK-MB)、天冬氨酸氨基转移酶(AST)]水平,并记录两组患者治疗期间不良事件发生情况。结果:观察组患者血糖达标时间、病情缓解时间、血pH值恢复时间均短于对照组(P<0.05);治疗2 d后,两组患者β-HB、Lac、血酮体、FPG、2hPG、HbA1c、心肌酶各项指标水平均较治疗前降低,且观察组低于对照组(P<0.05);治疗期间,两组患者不良事件总发生率比较,差异无统计学意义(P>0.05)。结论:胰岛素一次性冲击治疗可有效缓解患者临床症状,对患者各项治疗指标具有较好的优化效果,且不会增加患者不良事件发生率,具有较好的安全性。Objective:To explore the efficacy of one-time insulin shock therapy regimen on patients with diabetic ketoacidosis(DKA)and its effects on serum levels of blood ketone,creatine kinase(CK)and lactic acid.Methods:124 patients with DKA were selected and divided into observation group(n=62)and control group(n=62)by the different regimens of insulin intravenous injection.The control group was given continuous intravenous drip of low-dose insulin,while the observation group was given one-time insulin shock therapy and then treated with the same treatment regimen as the control group.The clinical indicators(time to reach the glycemic targets,disease remission time,blood pH recovery time),acidosis-related indicators[bloodβ-hydroxybutyric acid(β-HB),blood lactic acid(Lac),blood ketone body],blood glucose indicators[fasting plasma glucose(FPG),2h postprandial blood glucose(2hPG),glycosylated hemoglobin(HbA1c)]and myocardial enzymes[CK,creatine kinase isoenzyme(CK-MB),aspartate aminotransferase(AST)]were compared between the two groups before and after treatment,and the occurrence of adverse events during treatment were recorded in both groups.Results:The time to reach the glycemic targets,disease remission time and blood pH recovery time in observation group were shorter than those in control group(P<0.05).The levels ofβ-HB,Lac,blood ketone body,FPG,2hPG,HbA1c and myocardial enzymes in both groups after 2 days of treatment were decreased compared with those before treatment,and the above levels in observation group were lower compared with those in control group(P<0.05).During treatment,there was no statistical significance in the total incidence rate of adverse events between the two groups(P>0.05).Conclusion:One-time insulin shock therapy can effectively relieve the clinical symptoms of patients,and it has a good optimization effect on various therapeutic indicators of patients,and it does not increase the incidence rate of adverse events and has good safety.

关 键 词：糖尿病酮症酸中毒 胰岛素 静脉滴注 血酮体 肌酸激酶 血乳酸 

分 类 号：R587.2[医药卫生—内分泌]