中华糖尿病杂志
中華糖尿病雜誌
중화당뇨병잡지
CHINES JOURNAL OF DLABETES MELLITUS
2009年
5期
341-345
,共5页
黄武%刘幼硕%王艳姣%龙利民%王翼%詹俊鲲
黃武%劉幼碩%王豔姣%龍利民%王翼%詹俊鯤
황무%류유석%왕염교%룡이민%왕익%첨준곤
门冬胰岛素%人胰岛素%危重症%应激性高血糖%强化胰岛素治疗
門鼕胰島素%人胰島素%危重癥%應激性高血糖%彊化胰島素治療
문동이도소%인이도소%위중증%응격성고혈당%강화이도소치료
Insulin aspart%Human regular insulin%Critical care patients%Stress-induced hyperglycemia%Intensive insulin therapy
目的 比较门冬胰岛素和人胰岛素强化治疗内科危重症高血糖的有效性和安全性.方法 选取中南大学湘雅二医院老年病科符合全身炎症反应综合征诊断标准的内科危重患者186例,入组时空腹血糖水平为(10.8±2.3)mmoL/L,根据患者入组时恢复进食情况分为多次皮下注射胰岛素组(MDI,n=90)和持续皮下注射胰岛素组(CSⅡ,n=96),2组均随机分为门冬胰岛素和人胰岛素亚组.MDI组中门冬胰岛素和人胰岛素亚组分别为44、46例,CSⅡ组分别为46、50例.MDI组餐前大剂量采用门冬胰岛素或人胰岛素,基础量均采用甘精胰岛素,CSⅡ组餐前大剂量及基础量均采用门冬胰岛素或人胰岛素.根据多点指尖血糖监测结果调整胰岛素用量,强化胰岛素治疗疗程7 d,使血糖控制在4.4～8.3 mmol/L,7 d后改为常规胰岛素治疗,使血糖控制在4.4～11.1 mmol/L,观察各哑组患者基线及第7天日内平均血糖水平、日内血糖标准差、日内血糖极差(最高和最低血糖之差)、血清C反应蛋白(CRP)水平、急性生理与慢性疾病评分(APACHE Ⅱ),统计7 d内低血糖发生率、严重低血糖发生率、日平均胰岛素用量及28 d内各组死亡率.统计学分析采用t检验和x~2检验.结果 (1)MDI及CSⅡ组的门冬胰岛素亚组和人胰岛素亚组强化治疗各项指标差异无统计学意义.(2)强化治疗后第7天门冬胰岛素哑组较人胰岛素组日内平均血糖水平更低,MDI组:(6.2±1.3)mmol/L比(7.6±1.6)mmol/L;CSⅡ组:(6.0±1.2)mmol/L比(7.4±2.5)mmol/L,均P＜0.05.(3)门冬胰岛素亚组血糖标准差更小,MDI组:(1.54±0.27)mmol/L比(1.92±0.38)mmol/L;CSⅡ组:(1.24±0.27)mmol/L比(1.83±0.45)mmol/L,均P＜0.05.(4)门冬胰岛素亚组极差更小,MDI组:(3.0±0.5)mmoL/L vs(3.9±1.1)mmoL/L;CSⅡ组:(3.1±0.6)mmol/L vs(3.9±1.0)mmol/L,均P＜0.05.(5)门冬胰岛素业组7 d内日平均胰岛素用量更少,低血糖发生率及严重低血糖发生率更低.同时,门冬胰岛素亚组7 d内血清CRP水平下降更明显,APACHEⅡ评分下降更明显.(6)28 d内死亡率无统计学差异(MDI组:13.0% vs 13.6%;CSⅡ组:6.0% vs 6.5%,均P＞0.05).结论 对于内科危重症伴高血糖患者,用门冬胰岛素强化治疗比人胰岛素能更好地控制血糖均值及波动,减少低血糖发生,节约胰岛素用量并减轻炎症反应.
目的 比較門鼕胰島素和人胰島素彊化治療內科危重癥高血糖的有效性和安全性.方法 選取中南大學湘雅二醫院老年病科符閤全身炎癥反應綜閤徵診斷標準的內科危重患者186例,入組時空腹血糖水平為(10.8±2.3)mmoL/L,根據患者入組時恢複進食情況分為多次皮下註射胰島素組(MDI,n=90)和持續皮下註射胰島素組(CSⅡ,n=96),2組均隨機分為門鼕胰島素和人胰島素亞組.MDI組中門鼕胰島素和人胰島素亞組分彆為44、46例,CSⅡ組分彆為46、50例.MDI組餐前大劑量採用門鼕胰島素或人胰島素,基礎量均採用甘精胰島素,CSⅡ組餐前大劑量及基礎量均採用門鼕胰島素或人胰島素.根據多點指尖血糖鑑測結果調整胰島素用量,彊化胰島素治療療程7 d,使血糖控製在4.4～8.3 mmol/L,7 d後改為常規胰島素治療,使血糖控製在4.4～11.1 mmol/L,觀察各啞組患者基線及第7天日內平均血糖水平、日內血糖標準差、日內血糖極差(最高和最低血糖之差)、血清C反應蛋白(CRP)水平、急性生理與慢性疾病評分(APACHE Ⅱ),統計7 d內低血糖髮生率、嚴重低血糖髮生率、日平均胰島素用量及28 d內各組死亡率.統計學分析採用t檢驗和x~2檢驗.結果 (1)MDI及CSⅡ組的門鼕胰島素亞組和人胰島素亞組彊化治療各項指標差異無統計學意義.(2)彊化治療後第7天門鼕胰島素啞組較人胰島素組日內平均血糖水平更低,MDI組:(6.2±1.3)mmol/L比(7.6±1.6)mmol/L;CSⅡ組:(6.0±1.2)mmol/L比(7.4±2.5)mmol/L,均P＜0.05.(3)門鼕胰島素亞組血糖標準差更小,MDI組:(1.54±0.27)mmol/L比(1.92±0.38)mmol/L;CSⅡ組:(1.24±0.27)mmol/L比(1.83±0.45)mmol/L,均P＜0.05.(4)門鼕胰島素亞組極差更小,MDI組:(3.0±0.5)mmoL/L vs(3.9±1.1)mmoL/L;CSⅡ組:(3.1±0.6)mmol/L vs(3.9±1.0)mmol/L,均P＜0.05.(5)門鼕胰島素業組7 d內日平均胰島素用量更少,低血糖髮生率及嚴重低血糖髮生率更低.同時,門鼕胰島素亞組7 d內血清CRP水平下降更明顯,APACHEⅡ評分下降更明顯.(6)28 d內死亡率無統計學差異(MDI組:13.0% vs 13.6%;CSⅡ組:6.0% vs 6.5%,均P＞0.05).結論 對于內科危重癥伴高血糖患者,用門鼕胰島素彊化治療比人胰島素能更好地控製血糖均值及波動,減少低血糖髮生,節約胰島素用量併減輕炎癥反應.
목적 비교문동이도소화인이도소강화치료내과위중증고혈당적유효성화안전성.방법 선취중남대학상아이의원노년병과부합전신염증반응종합정진단표준적내과위중환자186례,입조시공복혈당수평위(10.8±2.3)mmoL/L,근거환자입조시회복진식정황분위다차피하주사이도소조(MDI,n=90)화지속피하주사이도소조(CSⅡ,n=96),2조균수궤분위문동이도소화인이도소아조.MDI조중문동이도소화인이도소아조분별위44、46례,CSⅡ조분별위46、50례.MDI조찬전대제량채용문동이도소혹인이도소,기출량균채용감정이도소,CSⅡ조찬전대제량급기출량균채용문동이도소혹인이도소.근거다점지첨혈당감측결과조정이도소용량,강화이도소치료료정7 d,사혈당공제재4.4～8.3 mmol/L,7 d후개위상규이도소치료,사혈당공제재4.4～11.1 mmol/L,관찰각아조환자기선급제7천일내평균혈당수평、일내혈당표준차、일내혈당겁차(최고화최저혈당지차)、혈청C반응단백(CRP)수평、급성생리여만성질병평분(APACHE Ⅱ),통계7 d내저혈당발생솔、엄중저혈당발생솔、일평균이도소용량급28 d내각조사망솔.통계학분석채용t검험화x~2검험.결과 (1)MDI급CSⅡ조적문동이도소아조화인이도소아조강화치료각항지표차이무통계학의의.(2)강화치료후제7천문동이도소아조교인이도소조일내평균혈당수평경저,MDI조:(6.2±1.3)mmol/L비(7.6±1.6)mmol/L;CSⅡ조:(6.0±1.2)mmol/L비(7.4±2.5)mmol/L,균P＜0.05.(3)문동이도소아조혈당표준차경소,MDI조:(1.54±0.27)mmol/L비(1.92±0.38)mmol/L;CSⅡ조:(1.24±0.27)mmol/L비(1.83±0.45)mmol/L,균P＜0.05.(4)문동이도소아조겁차경소,MDI조:(3.0±0.5)mmoL/L vs(3.9±1.1)mmoL/L;CSⅡ조:(3.1±0.6)mmol/L vs(3.9±1.0)mmol/L,균P＜0.05.(5)문동이도소업조7 d내일평균이도소용량경소,저혈당발생솔급엄중저혈당발생솔경저.동시,문동이도소아조7 d내혈청CRP수평하강경명현,APACHEⅡ평분하강경명현.(6)28 d내사망솔무통계학차이(MDI조:13.0% vs 13.6%;CSⅡ조:6.0% vs 6.5%,균P＞0.05).결론 대우내과위중증반고혈당환자,용문동이도소강화치료비인이도소능경호지공제혈당균치급파동,감소저혈당발생,절약이도소용량병감경염증반응.
Objective To observe the efficacy and safety of insulin aspart in intensive insulin therapy of hyperglycemia in medical critically ill patients.Methods A total of 186 medical critically ill patients with fasting blood glucose (10.8±2.3) mmol/L were divided into multiple daily insulin (MDI)group (n = 90) and continous subcutaneous insulin infusion (CSⅡ) group (n = 96),both groups were divided into insulin aspart subgroup and human regular insulin subgroup randomly.Bonus dosage was offered by insulin aspart or human regular insulin in MDI group,base dosage was offered by Glagine.Bonus and base dosage were offered by insulin aspart or human regular insuline in CSⅡ group.The dosage of insulin was adjusted according to multi-points blood glucose levels.The course of intensive insulin therapy was 7 days with blood glucose levels 4.4 ～ 8.3 mmol/L,and it was changed to regular insulin therapy after 7 days with blood glucose levels 4.4～11.1 mmol/L.Average blood glucose level,blood glucose standard deviation,the equation of the highest and the lowest blood glucose level in one day,percentage of total hypoglycemia and serious hypoglycemia,average insulin dosage,decline of blood CRP level and APACHE Ⅱ during 7 days,and mortality during twenty eight days were observed.Results (1) There were no statistical significance in difference on lab items before intensive insulin therapy in both subgroups.(2) Compared to human regular insulin subgroup,insulin aspart subgroup was lower in average blood glucose level.MDI group:(6.17±1.32) mmol/L vs (7.6±1.6) mmol/L;CSⅡ group:(6.0±1.2) mmol/L vs (7.4±2.5) mmol/L,P ＜0.05 respectively.Standard deviation MDI group:(1.54±0.27) mmol/L vs (1.92±0.38) mmol/L;CSⅡ group:(1.24 ±0.27) mmol/L vs (1.83±0.45) mmol/L,respectively (P＜0.05).The equation MDI group:(3.0±0.5)mmol/Lvs (3.9±1.1) mmol/L;CSII group:(3.1±0.6) mmoL/Lvs (3.9±1.0)mmol/L,respectively(P＜0.05).CSⅡ group were lower in seventh day of intensive insulin therapy;average insulin dosage was less (MDI group:(38±3)U/d vs (42±4)U/d;CSⅡ group:(37±4)U/d vs (40±6)U/d,P ＜0.05 respectively),percentage of total hypoglycemia (MDI group:17.4% vs 27.3%;CSⅡ group:8.0% vs 17.4%,P＜0.05 respectively) and serious hypoglycemia (MDI group:4.3% vs 15.9%;CSⅡ group:2.0% vs 6.5%,P ＜0.05 respectively) was lower during seven days,decline of blood CRP level during seven days was more obvious (MDI group:(44.8±1.6) mg/L vs (27.8±1.2) mg/L;CSⅡ group:(57.7±2.4) mg/L vs (36.7 ±1.2) mg/L,P＜0.05 respectively),decline of APACHE Ⅱ during seven days was more obvious (MDI group:(7.5±2.1) score vs (4.3±1.1) score;CSⅡ group:(8.4±1.3) score vs (6.1±1.5) score,P＜0.05 respectively);mortality was not different in statistical during twenty eight days (MDI group:13.0% vs 13.6%;CSⅡ group:6.0% vs 6.5%,P＞0.05 respectively).Conclusion Insulin aspart can better control average blood glucose and its variability,lower the percentage of hypoglycemia,save insulin dosage and relieve inflammation than human regular insulin in treating hyperglycemia of medical critically ill patients.
