胰岛素泵和多次胰岛素皮下注射治疗对糖尿病酮症酸中毒和高渗昏迷的疗效比较

目的比较不同胰岛素给药方法对糖尿病酮症酸中毒（DKA）和糖尿病高渗性昏迷（DHC）的疗效。方法对DKA和DHC患者首先用静脉泵小剂量胰岛素持续输注,在生命体征平稳并能进半流食后分别用不同的胰岛素给药方式进行治疗：（1）持续皮下胰岛素输注（CSII）组;（2）常规4次皮下注射胰岛素（MSII）组。治疗目标为FBG≤7.0mmol/L、2hBG≤10mmol/L。结果两组每日胰岛素用量无统计学差异（P〉0.05）,但平均达标天数CSII组较MSII组明显缩短（P〈0.01）,CSII组血糖波动小,发生低血糖次数明显减少,且FBG及晚餐后2hBG控制亦明显优于MSII组（P〈0.01）。结论在治疗DKA和DHC时采用静脉泵连续小剂量胰岛素输注急救后,使用CSII较MSII能更快、更平稳、更有效地控制高血糖。

Comparison of the therapeutic efficacy between CSII and MSII treatments of diabetic ketoacidosis (DKA) and diabetic hyperosmolar coma(DHC)

Objective To compare the effect of different approaches of insulin delivery on hyperglycemia. Methods The patients with DKA or DHC were firstly intravenously infused with a low dose of insulin. After all cases got stable vital signs and were given semiliquid diet, they were divided into two groups.. （1） Continuous subcutaneous insulin infusion （CSII） with insulin pump, （2） Multisubucutaneous insulin injection （MSII）. The targets of blood glucose were fasting glucoseS7.0mmol/L, 2-hour postprandial blood glucose≤10mmol/1. Results There was no significant difference in a daily insulin dosage between the two groups （P〉 0.05）. The CSII group reached the glucose target more quickly than did the MSII group （P〈0. 001）. The blood fluctuation and the hypoglycemia frequency were significantly decreased in the CSII group versus MSII group. Conclusions As far as the low dose insulin treatment of DKA and DHC is concerned, CSII controls hyperglycemia more quickly,more equably, and more effectively than does MSII.