乌司他丁联合胰岛素泵持续皮下给药治疗糖尿病酮症酸中毒合并感染性休克的临床疗效研究  

Clinical Efficacy of Ulinastatin Combined with Continuously Subcutaneous Administration of Insulin Pump in the Treatment of Diabetic Ketoacidosis Complicated with Septic Shock

作　　者：李世平 吝新英 范平平 LI Shiping;QIAN Xinying;FAN Pingping(Dept.of Emergency ICU,Zhangjiakou First Hospital,Hebei Zhangjiakou 075000,China)

机构地区：[1]张家口市第一医院急诊ICU,河北张家口075000

出　　处：《中国医院用药评价与分析》2024年第6期685-688,692,共5页Evaluation and Analysis of Drug-use in Hospitals of China

基　　金：河北省医学科学研究课题计划项目(No.20221601);张家口市重点研发计划项目(No.2221228D)。

摘　　要：目的:探讨乌司他丁联合胰岛素泵持续皮下给药治疗糖尿病酮症酸中毒(DKA)合并感染性休克患者的临床疗效。方法:选择2021年6月至2023年7月该院收治的DKA合并感染性休克患者80例,采用随机数表法分为对照组(40例)和研究组(40例)。两组患者均给予常规治疗,在常规治疗的基础上,对照组患者给予胰岛素泵持续皮下注射胰岛素注射液,研究组患者在对照组的基础上给予注射用乌司他丁。比较两组患者的临床指标、酸中毒及血糖指标、T淋巴细胞亚群、炎症和氧化应激指标水平,以及不良反应、临床疗效。结果:研究组患者的总有效率为90.00%(36/40),较对照组的72.50%(29/40)显著升高,差异有统计学意义(P<0.05)。研究组患者尿酮体转阴时间、血糖恢复时间和pH纠正时间短于对照组,差异均有统计学意义(P<0.05)。治疗后,两组患者血乳酸(Lac)、血酮体(KET)、空腹血糖(FBG)、糖化血红蛋白(HbA_(1)c)、CD8^(+)、肿瘤坏死因子α(TNF-α)、降钙素原(PCT)和丙二醛(MDA)水平降低,且研究组患者Lac、KET、FBG、HbA_(1)c、CD8^(+)、TNF-α、PCT和MDA水平低于对照组,差异均有统计学意义(P<0.05)。治疗后,两组患者二氧化碳结合力(CO_(2)CP)、CD4^(+)、CD3^(+)、CD4^(+)/CD8^(+)和超氧化物歧化酶(SOD)水平升高,且研究组患者CO_(2)CP、CD4^(+)、CD3^(+)、CD4^(+)/CD8^(+)和SOD水平高于对照组,差异均有统计学意义(P<0.05)。研究组、对照组患者的不良反应发生率比较[10.00%(4/40)vs.7.50%(3/40)],差异无统计学意义(P>0.05)。结论:乌司他丁联合胰岛素泵持续皮下给药治疗DKA合并感染性休克,可改善患者临床症状、酸中毒及血糖指标和免疫功能,调节炎症、氧化应激状态,治疗效果显著且安全。OBJECTIVE:To probe into the clinical efficacy of ulinastatin combined with continuously subcutaneous administration of insulin pump in the treatment of diabetic ketoacidosis(DKA)complicated with septic shock.METHODS:A total of 80 patients with DKA complicated with septic shock admitted to Zhangjiakou First Hospital from Jun.2021 to Jul.2023 were selected to be divided into control group(40 cases)and research group(40 cases)via the random number table method.Both groups were given conventional treatment,the control group was given continuously subcutaneous insulin injection of insulin pump on the basis of conventional treatment,the research group was given ulinastatin for injection basis on the control group.The clinical indicators,acidosis and blood glucose indicators,T lymphocyte subsets,inflammation and oxidative stress indicators,adverse drug reactions and clinical efficacy were compared between two groups.RESULTS:The total effective rate of the research group was 90.00%(36/40),significantly higher than 72.50%(29/40)of control group,with statistically significant difference(P<0.05).The negative-conversion time of urine ketone body,recovery time of blood glucose and correction time of pH in the research group were shorter than those in the control group,with statistically significant differences(P<0.05).After treatment,the levels of blood lactic acid(Lac),blood ketone body(KET),fasting blood glucose(FBG),glycated hemoglobin(HbA_(1)c),CD8^(+),tumor necrosis factorα(TNF-α),procalcitonin(PCT)and malondialdehyde(MDA)of both groups were decreased,the levels of Lac,KET,FBG,HbA_(1)c,CD8^(+),TNF-α,PCT and MDA in the research group were lower than those in the control group,with statistically significant differences(P<0.05).After treatment,the levels of carbon dioxide binding power(CO_(2)CP),CD4^(+),CD3^(+),CD4^(+)/CD8^(+)and superoxide dismutase(SOD)of both groups increased,the levels of CO_(2)CP,CD4^(+),CD3^(+),CD4^(+)/CD8^(+)and SOD in the research group were higher than those in the control group,with statistical

关 键 词：乌司他丁 胰岛素泵 糖尿病酮症酸中毒 感染性休克 

分 类 号：R977.15[医药卫生—药品] R977[医药卫生—药学]