胰岛素泵在糖尿病酮症酸中毒治疗中的应用

　　摘 要 目的：比较胰岛素泵持续皮下注射胰岛素法(CSII)和小剂量胰岛素静脉持续滴注法对糖尿病酮症酸中毒治疗中的疗效和安全性。方法：将51例糖尿病酮症酸中毒患者随机分为A组(CSII治疗组)26例和B组(小剂量胰岛素静脉持续滴注组)25例，对血糖达标、尿酮转阴和血pH值恢复时间以及低血糖发生情况进行对比分析。结果：两组均可使血糖明显下降，血糖达标时间无显著性差异;A组尿酮转阴时间、血pH值恢复时间明显短于B组;A组低血糖发生率明显低于B组。结论：与常规小剂量胰岛素静脉持续滴注法相比，CSII对糖尿病酮症酸中毒的治疗是更为安全、有效的。

　　关键词 胰岛素泵;糖尿病酮症酸中毒

　　The Application of Insulin Pump to Treatment of Diabetic Ketoacidosis

　　ZHANG Yang, JIANG Xia, HAN Baoling

　　(Department of Endocrinology,First Central Hospital, Tianjin 300192,China)

　　Abstract Objective: To compare the effect and the safety of continue subcutaneous insulin injection (CSII) and low dose insulin intravenous infusion in treatment of diabetic ketoacidosis. Methods: 51 diabetic ketoacidosis patients were divided into two groups. Group A (CSII group) had 26 cases; Group B (low dose insulin intravenous infusion group) had 25 cases.A comparison was made among the recovering time of blood glucose and plasma PH, the disappearing time of urinary ketobodies, and the frequency of hypoglycemia incidence. Results: The blood sugar obviously declined in each group. There was no significant difference in the average recovering time of blood glucose between two groups. The disappearing time of urinary ketobodies and the recovering time of plasma PH in group A was significantly shorter than that in group B (P<0.05). The frequency of hypoglycemia incidence in group A was significantly lower than that in group B (P<0.05). Conclusion: The CSII was more safe and effective than low dose insulin intravenous infusion in the treatment of diabetic ketoacidosis.

　　Key words Insulin pump; Diabetic ketoacidosis

　　糖尿病酮症酸中毒是糖尿病最常见的代谢紊乱并发症，系由于在各种诱因的作用下，胰岛素不足明显加重、升糖激素不适当升高而导致的糖、脂肪、蛋白质、水、电解质及酸碱的平衡失调，严重威胁患者生命。其常规的胰岛素治疗方法是小剂量胰岛素静脉持续滴注。近年来，胰岛素泵的应用研究取得了较大的进展。现总结我科应用胰岛素泵持续皮下注射胰岛素法(CSII)治疗糖尿病酮症酸中毒的资料，现报告如下。

　　1 对象与方法

　　1.1 病例选择选取我科自2002年3月至2004年12月收治的糖尿病酮症酸中毒患者51例，其诊断均符合1999年WHO糖尿病的诊断标准。按照随机化原则分为两组。A组为CSII治疗组，共2

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