CAJ | 학술논문

目的了解全合一肠外营养中添加胰岛素对极低出生体重儿(VLBWI)血糖的影响.方法将42例2005年9月至2009年3月在东南大学附属徐州医院儿科住院且应用全合一肠外营养的VLBWI随机分成3组:Ⅰ组(13例)添加胰岛素的输注速度为0.4 U·kg-1·h-1;Ⅱ组(13例)输注速度为0.1 U·kg-1·h-1;Ⅲ组(16例)不添加胰岛素.每2小时监测血糖一次.比较3组间血糖异常率的差异,分析入院时胰岛素水平与静脉血糖的相关性.结果各组1周内检测到高血糖、低血糖的异常率分别为:Ⅰ组10.9%(29/265)、18.1%(48/265),Ⅱ组20.8%(59/284)、14.1%(40/284),Ⅲ组20.5%(61/298)、11.7%(35/298).Ⅰ组和Ⅱ组之间(x2=9.844,P=0.002)、Ⅰ组和Ⅲ组之间(x2=9.478,P=0.002)高血糖发生率差异有统计学意义;Ⅱ组和Ⅲ组之间高血糖发生率差异无统计学意义(x2=0.008,P=0.928).Ⅰ组和Ⅲ组之间低血糖发生率差异有统计学意义(x2=4.526,P=0.033);Ⅰ组和Ⅱ组之间(x2=1.653,P=0.199)、Ⅱ组和Ⅲ组之间(x2=0.709,P=0.400)低血糖发生率差异无统计学意义.入院时内源性胰岛素水平与静脉血糖水平无明显相关(r=0.082,P=0.661).结论 VLBWI血糖的高低无法靠内源性胰岛素及时调节.在全合一肠外营养中添加胰岛素,以0.1 U·kg-1·h-1输注时,高血糖发生率无明显减少,而低血糖发生率稍增高;以0.4U·kg-1·h-1输注时,高血糖发生率减少,但低血糖发生率增加,故不建议在应用于VLBWI的全合一肠外营养中预防性添加外源性胰岛素.
목적 료해전합일장외영양중첨가이도소대겁저출생체중인(VLBWI)혈당적영향.방법 장42례2005년9월지2009년3월재동남대학부속서주의원인과주원차응용전합일장외영양적VLBWI수궤분성3조:Ⅰ조(13례)첨가이도소적수주속도위0.4 U·kg-1·h-1;Ⅱ조(13례)수주속도위0.1 U·kg-1·h-1;Ⅲ조(16례)불첨가이도소.매2소시감측혈당일차.비교3조간혈당이상솔적차이,분석입원시이도소수평여정맥혈당적상관성.결과 각조1주내검측도고혈당、저혈당적이상솔분별위:Ⅰ조10.9%(29/265)、18.1%(48/265),Ⅱ조20.8%(59/284)、14.1%(40/284),Ⅲ조20.5%(61/298)、11.7%(35/298).Ⅰ조화Ⅱ조지간(x2=9.844,P=0.002)、Ⅰ조화Ⅲ조지간(x2=9.478,P=0.002)고혈당발생솔차이유통계학의의;Ⅱ조화Ⅲ조지간고혈당발생솔차이무통계학의의(x2=0.008,P=0.928).Ⅰ조화Ⅲ조지간저혈당발생솔차이유통계학의의(x2=4.526,P=0.033);Ⅰ조화Ⅱ조지간(x2=1.653,P=0.199)、Ⅱ조화Ⅲ조지간(x2=0.709,P=0.400)저혈당발생솔차이무통계학의의.입원시내원성이도소수평여정맥혈당수평무명현상관(r=0.082,P=0.661).결론 VLBWI혈당적고저무법고내원성이도소급시조절.재전합일장외영양중첨가이도소,이0.1 U·kg-1·h-1수주시,고혈당발생솔무명현감소,이저혈당발생솔초증고;이0.4U·kg-1·h-1수주시,고혈당발생솔감소,단저혈당발생솔증가,고불건의재응용우VLBWI적전합일장외영양중예방성첨가외원성이도소.
Objective To investigate influence of exogenous insulin in all-in-one parenteral nutrition on blood glucose in infants with very low birth weight (VLBW). Methods Forty-two infants with VLBWI admitted to the department of pediatrics of Xuzhou Hospital affiliated to Southeast University during September 2005 to March 2009 were randomly assigned to Group Ⅰ ( n = 13 ) with exogenous insulin added to all-in-one parenteral nutrition at infusion rate of 0.4 U·kg-1·h-1,GroupⅡ(n = 13) with exogenous insulin at infusion rate of 0.1U·kg-1·h-1 and Group Ⅲ (n = 16) with no exogenous insulin added.Their blood glucose was monitored every two hours. Chi-square test was used for comparing difference in blood glucose abnormality between the three groups and association between blood glucose levels at admission and during hospitalization was analyzed with Spearman correlation. Results Incidence of hyperglycemia and hypoglycemia was 10. 9 percent (29/265) and 18. 1 percent (48/265) in Group Ⅰ, 20. 8 percent (59/284) and 14. 1 percent (40/284) in Group Ⅱ , and 20. 5 percent (61/298) and 11.7 percent (35/298) in Group Ⅲ, respectively. There was significant difference in incidence of hyperglycemia between Groups Ⅰ and Ⅱ ( x2 = 9. 844, P = 0. 002 ) and between Groups Ⅰ and Ⅲ ( x2 = 9. 478, P = 0. 002 ), but no significant difference in it between Groups Ⅱ and Ⅲ ( x2 = 0. 008, P = 0. 928 ). There was significant difference in incidence of hypoglycemia between Groups Ⅰ and Ⅲ ( x2 = 4. 526, P =0. 033 ), but no significant difference in it between Groups Ⅰ and Ⅱ (x2 =1.653, P=0. 199) or between Groups Ⅱ and Ⅲ (x2 =0.709, P =0.400).No significant correlation between endogenous blood insulin level at admission and during hospitalization( r = 0. 082, P = 0. 661 ) was found. Conclusions Blood glucose in infants with VLBW can not be regulated timely by their endogenous insulin itseff. Exogenous insulin added to all-in-one parenteral nutrition at infusion rate of 0. 1 U · kg-1 · h-1 may not significantly reduce incidence of hyperglycemia,while incidence of hypoglycemia can be reduced by exogenous insulin at infusion rate of 0. 4 U · kg- 1 · h -1 that can increase incidence of hypoglycemia Therefore, exogenous insulin is not recommended to be prophylactically added to all-in-one parenteral nutrition for infants with VLBW.