全合一肠外营养中胰岛素对极低出生体重儿血糖的影响

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0．4U·kg·h-1；Ⅱ组（13例）输注速度为0．1U·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（χ2=9．844，P=0．002）、I组和Ⅲ组之间（χ2=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（χ2=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（χ2=4．526，P=0．033）；I组和Ⅱ组之间（χ2=1．653，P=0．199）、Ⅱ组和Ⅲ组之间（χ2=0．709，P=0．400）低血糖发生率差异无统计学意义。人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0．1U·kg～·h“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。

Influence of insulin in all-in-one parenteral nutrition on blood glucose level in infants of very low birth weight

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.