胰岛素泵和多次胰岛素皮下注射治疗老年危重症高血糖的有效性和安全性比较

目的 比较持续皮下注射胰岛素(CSII,即胰岛素泵)和多次皮下注射胰岛素(MDI)强化治疗改善老年危重症高血糖的有效性和安全性.方法 选择本院老年危重病患者94例,入组时空腹血糖为(10.3±2.5)mmol/L;随机分为CSII组(46例)和MDI组(48例),两组均注射可溶性人胰岛素,连续治疗7 d,观察两组血糖控制情况、7 d内日平均胰岛素用量、低血糖发生率.第7日血清C-反应蛋白(CRP)、肿瘤坏死因子-a(TNF-a)、白细胞介素-6(IL-6)水平、急性生理学与慢性健康状况评分系统Ⅱ(APACHE Ⅱ)评分以及28 d病死率.结果 与MDI组比较,CSII组血糖控制更好,血糖控制良好率[76.1%(35/46)比33.3%(16/48)3及血糖控制尚可率更高[21.7%(10/46)比14.6%(7/48)3,而控制差的更低[2.2%(1/46)比52.1%(25/48)];低血糖发生率更低(10.9%(5/46)比22.9%(11/48)],7 d内日平均胰岛素用量更少[(40.1±6.3)U/d比(46.2±7.1)U/d];血清TNF-a[(11.54±2.7)μg/L比(19.8±4.2)μg/L]、IL-6水平[(78.3±5.1)μg/L比(141.4±6.2)μg/L]、CRP水平[(53.1±3.3)mg/L比(72.1±4.0)mg/L3明显低于MDI组;APACHE Ⅱ评分明显低于MDI组[(6.0±1.4)分比(11.6±1.0)分];CSII组28 d病死率低于MDI组(4.3%(2/46)比16.7%(8/48)3;差异均有统计学意义(P均<0.05).结论 胰岛素泵较多次皮下注射治疗可更好地控制危重症高血糖,减轻炎症反应及改善短期预后.

A comparison of efficacy and safety in the treatment of hyperglycemia with continuous subcutaneous insulin with insulin pump or multiple insulin injections daily in critical elderly patients

OBJECTIVE: To compare efficacy and safety in the treatment of hyperglycemia with continuous subcutaneous insulin infusion (CSII) or multiple daily insulin injection (MDI) in critical elderly patients. METHODS: Ninety-four elderly patients in critical condition with fasting glucose (10.3+/-2.5) mmol/L were randomly divided into CSII group (46 cases) and MDI group (48 cases). Soluble human insulin was used in both groups, and the treatment lasted for 7 days, and blood glucose level, average insulin dosage, percentage of hypoglycemia during 7 days, blood C-reacting protein (CRP), tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6) level and acute physiology and chronic health evaluationII (APACHEII) scores on the 7th day, and mortality during 28 days were observed. RESULTS: Compared with MDI group, blood glucose was better controlled [76.1% (35/46) vs. 33.3% (16/48)], percentage of fair control of blood glucose level was higher [21.7% (10/46) vs. 14.6% (7/48)], percentage of poor control of blood glucose level was lower [2.2% (1/46) vs. 52.1% (25/48)], percentage of hypoglycemia was lower [10.9% (5/46) vs. 22.9% (11/48)], average insulin dosage during 7 days was less [(40.1+/-6.3) U/d vs. (46.2+/-7.1) U/d], serum TNF-alpha level [(11.5+/-2.7) mug/L vs. (19.8+/-4.2) mug/L], IL-6 level [(78.3+/-5.1)mug/L vs.(141.4+/-6.2) mug/L] and CRP level [(53.1+/-3.3) mg/L vs. (72.1+/-4.0) mg/L] on the 7th day was lower, APACHEIIscore was lower on the 7th day [(6.0+/-1.4) scores vs. (11.6+/-1.0) scores], and 28-day mortality was lower in CSII group [4.3% (2/46) vs. 16.7% (8/48)]. All the above values showed statistically significant difference between two groups (all P<0.05). CONCLUSION: CSII can better control blood glucose and alleviate inflammatory response and improve prognosis in elderly critically ill patients.