胃肠外营养时胰岛素不同给药方法对病人血糖和尿糖的影响

[目的]探讨胰岛素在胃肠外营养（TPN）时不同给药方法对病人血糖和尿糖的影响。[方法]将我科同一医生治疗的食管癌或贲门癌术后病人，在相同的TPN配方条件下选择60例，随机分为两组，每组30例，对照组将诺和灵R采用三通与静脉营养液同步泵入；实验组将诺和灵R加入全合一营养液袋中输注，两组病人输液均用相同的输液泵、相同的输液速度进行控速管理。分别测量两组病人在开始输注营养液时、输注1000mL时、输注2000mL时和剩余100mL时的血糖和尿糖（连续测7d）以及所对应时点的胰岛素浓度和活性（留3d样本）。[结果]随着时间的推移，两组胰岛素活性均轻微下降、胰岛素浓度均轻微升高，但两组组内各时点的胰岛素活性、胰岛素浓度比较差异均无统计学意义，两组各时点胰岛素活性比较也无统计学意义；两组各时点尿糖比较差异均无统计学意义（P〉0．05）；两组各时点血糖、各组内各时点血糖比较差异均无统计学意义（P〉0．05）。[结论]胰岛素在TPN时不同的给药方法对病人血糖和尿糖控制效果差异不明显，将胰岛素加入营养液袋中进行输注也是可行的。     

应用全静脉营养时胰岛素不同的给药方法对患者血糖和尿糖的影响

目的：探讨胰岛素在全静脉营养时不同的给药方法对患者血糖和尿糖的影响。方法：将2008年1～12月我科食管贲门癌术后患者,在相同的TPN配方条件下选择60例,并随机分为对照组和实验组各30例,对照组诺和灵R（中效胰岛素）采用静脉营养袋以微量泵的形式按比例同步泵入;实验组则将诺和灵R加入全合一营养袋里输注,两组患者均采用相同的输液泵和输液速度进行控速管理。分别测量两组患者在开始输注营养液时、输注1000ml时、输注2000ml和剩余100ml时所对应时点的血糖和尿糖（连续测7d）以及所对应时点的胰岛素的浓度和活性（保留3d）。结果：两组给药方法各时点胰岛素的活性百分比无明显差异（P＆gt;0.05）,胰岛素的活性随时间的延长而活性稍降低;两组各时点的胰岛素浓度相互之间无明显差异（P＆gt;0.05）;两组组内,组间各时点的血糖及尿糖均无明显差异（P＆gt;0.05）;两组低血糖的发生率无明显差异（P＆gt;0.05）。结论：为了减轻临床护士的工作量,将胰岛素加入营养袋中进行输注是可行的。     

胃癌合并糖尿病患者术后全胃肠外营养时胰岛素给药方法对血糖控制的观察

目的：探讨胃癌合并糖尿病患者术后给予全胃肠外营养（TPN）支持中,不同胰岛素给予途径对血糖的控制效果。方法：分析45例胃癌合并糖尿病患者术后TPN输注时,比较两种不同胰岛素使用方法对患者血糖浓度的影响。结果：实验组在术后3天的血糖控制、及血糖波动均较对照组效果好;促进患者伤口愈合,减少术后住院时间。结论：对于胃癌合并糖尿病患者术后使用TPN治疗时,通过微量泵泵入胰岛素易于调整胰岛素用量,能更加快速、平稳、理想的控制血糖。     

胰岛素不同的给药途径与护理

胰岛素制剂类型、种类、注射技术、胰岛素抗体、注射部位、患者的反应性差异等可影响胰岛素的起效时间、作用强度和作用维持时间，现将胰岛素不同的给药途径及其特点与护理介绍如下。     

两种不同胰岛素给药方法对糖尿病病人血糖影响的临床观察

[目的]对两种不同的胰岛素给药方法,在胰岛素总用量、血糖达标时间、低血糖发生率方面进行比较。[方法]选择86例住院使用胰岛素治疗的2型糖尿病病人,回顾性分为持续皮下胰岛素泵注射组(CSⅡ组)与静脉输注泵加常规皮下注射胰岛素治疗组,采取不同的给药方法治疗,比较效果。[结果]两种方法均能有效降低血糖,但胰岛素总用量、血糖达标时间、低血糖发生率CSⅡ组显著少于静脉输注泵组。[结论]胰岛素泵强化治疗2型糖尿病更能较快、平稳控制血糖,优于静脉输注泵加常规皮下注射胰岛素治疗,并可减少低血糖发生的危险,缩短住院时间,减少胰岛素用量,减轻病人的负担。     

不同胰岛素给药方法对糖尿病治疗的疗效差异研究

研究分析不同胰岛素给药方法对糖尿病治疗的疗效差异。选取2016年3月~2017年1月期间在我院进行诊治的92例糖尿病患者,以随机的方式将患者分成研究组与对照组,组间均46例;所有患者在治疗中均应用胰岛素进行治疗,其中研究组通过胰岛素泵连续皮下输注的方式进行治疗,对照组通过胰岛素多次连续皮下注射的方式进行治疗,观察分析患者的治疗效果。所有患者的治疗均完成后,组间治疗效果对比,研究组明显优于对照组(P<0.05),且患者的低血糖发生情况对比,研究组较对照组明显减少(P<0.05)。在糖尿病患者的胰岛素用药治疗中,采用胰岛素泵连续皮下输注的方式进行治疗,能够获取满意的临床效果,临床应用价值更高。     

胰岛素不同的给药途径及护理

胰岛素制剂类型、种类、注射技术、胰岛素抗体、注射部位、患者的反应性差异等可影响胰岛素的起效时问、作用强度和作用维持时间，现将胰岛素不同的给药途径及其特点与护理综述如下。     

胰岛素不同的给药途径与护理

由于胰岛素是肽类激素 ,在胃肠道内易被消化酶分解代谢 ,因此 ,目前基本上是注射给药 ,其他给药途径也曾试验过 ,由于给药途径不同 ,胰岛素应用的适应症给药后吸收速度、作用时间以及引起的副作用等也不尽相同 ,下面将胰岛素的几种给药途径及护理要点介绍如下。1　常用的给药途径1 1　静脉注射。适用于重症糖尿病酮症酸中毒、糖尿病非酮症高渗性昏迷者 ,严重外伤、感染等合并外科手术前、中、后不能进食者。护理要点。胰岛素静注后即刻发挥作用 ,高峰在 30ｍｉｎ出现 ,半衰期 2 0ｍｉｎ ,持续时间短 ,仅为 2ｈ ,故临床静滴时主张小剂量持续…     

Fructose,xylitol and glucose in total parenteral nutrition

A comparison was made between isocaloric amounts of 24% glucose and 24% Triofusin^® (composed of 120 g fructose, 60 g glucose and 60 g xylitol per liter) during the course of a 6-day, 3-phase crossover study of 15 patients undergoing total parenteral nutrition. The patients received a total of 0.5 g carbohydrate per kilogram body weight per hour and 6 g carbohydrate per kg per day. Plasma glucose was significantly higher during glucose infusion (7–22 mmol/l, median: 9 mmol/l) than during Triofusin^® infusion (5–16 mmol/l, median: 6 mmol/l). A moderate to severe glucosuria was detected in three patients during infusion of 24% glucose, and this declined considerably during the Triofusin^® period. The total renal carbohydrate loss during the glucose period was 0–143 g, median: 6 g per day, and during the Triofusin^® period was 6–68 g, median: 10 g per day. The nitrogen balance and carbamide production rate were the same in the two infusion regimes. Changes in biochemical liver parameters were observed in most of the patients, but these could not be attributed to parenteral nutrition. None of the patients developed symptoms of metabolic acidosis. There was a slightly but significantly higher urinary excretion of oxalate in the Triofusin^® period (0.1–1.1 mmol per day, median: 0.5 mmol per day) than in the glucose period (0.1–1.0 mmol per day, median: 0.4 mmol per day). Most of the patients exhibited a slightly increased urinary excretion of urate, irrespective of the infusion regimen. Serum urate remained normal. It was concluded that Triofusin^® infused in the described dosage is a suitable calorie source for parenteral nutrition, but that it does not present a distinct advantage over the use of pure glucose solution. In patients suffering from reduced glucose tolerance, however, Triofusin^® represents a more easily manageable calorie source.This work was supported by grants from the Danish Medical Research Council (J.No. 512-15484), King Christian X's Foundation, P. Carl Petersen's Foundation and the Foundation for Advancement of Medical Science     

不同血糖浓度患者尿微量白蛋白指标分析

目的探讨不同糖尿病患者尿微量白蛋白(MA)指标检测的意义。方法随机选取100例门诊及住院患者病例样本分为健康对照组、糖尿病前期组和2型糖尿病组,检测空腹静脉血糖和尿MA,并对检测结果进行比较分析。结果健康对照组、糖尿病前期组和2型糖尿病组间的比较差异有统计学意义(P<0.05)。结论对糖尿病前期患者定期进行MA检测,来对比监测病程发展对于早期发现糖尿病肾病,早治疗早预防,改善预后具有非常重要的家庭和社会意义。     

重症脑外伤早期肠内与肠外营养支持的血糖及胰岛素水平对比

目的对比重症脑外伤后早期肠内与肠外营养支持的血糖及胰岛素水平差异。方法将重症脑外伤病人随机分为早期胃肠道营养组(EEF组)和早期完全胃肠外营养组(TPN组),对比营养支持前后两组血糖及胰岛素水平的差异。结果两组在伤后第1、3、6天血糖及胰岛素水平显著升高(P＜0.01),伤后第3天TPN组及EEF组血糖及胰岛素水平达到高峰,伤后第14天两组血糖及胰岛素水平恢复正常范围。EEF组的血糖及胰岛素水平在伤后第3、6天显著低于TPN组(P＜0.05),伤后第1、14天两组的空腹血糖及胰岛素水平无显著差异(P＞0.05)。结论早期胃肠道营养支持对比胃肠外营养支持可更好地减轻重症脑损伤后的高血糖反应及胰岛素水平。     

加强的全肠外营养支持应用于恶性梗阻性黄疸术后患者的效果

Objective To investigate the effect of enhanced total parenteral nutrition support to patients after accepting surgery operation for malignant obstructive jaundice.Methods Randomly,72 cases of patients with malignant obstructive jaundice having a body capacity score of ≤4 before the operation were divided into two groups,i.e.,the enhanced total parenteral nutrition group of 36 patients,and the control group of 36 patients.For the enhanced total parenteral nutrition group,total parenteral nutrition (TPN) had been given from three days before the operation,and for the control group,TPN was given from 1 day after the operation.The following items were observed,including serum total proteins,albumin level,pre-albumin level,transferrin level,as well as the time for exhausting by anus after the operation,the occurrence rate of eomplieatious,and the days for staying in hospital after the operation.Results The observed index of the enhanced group at the third day and the 12th day are all higher than those of the control group.The time for anus exhausting between the two groups did not show a significance in statistics.And the occurrence rate of complications and the days for staying in hospital after the operation in the enhanced group were less than those of the control group.Conclusions Giving TPN to the patients with malignant obstructive jaundice three days before the operation,will help the patients recover and reduce complications and days for staying in hospital.     

加强的全肠外营养支持应用于恶性梗阻性黄疸术后患者的效果

Objective To investigate the effect of enhanced total parenteral nutrition support to patients after accepting surgery operation for malignant obstructive jaundice.Methods Randomly,72 cases of patients with malignant obstructive jaundice having a body capacity score of ≤4 before the operation were divided into two groups,i.e.,the enhanced total parenteral nutrition group of 36 patients,and the control group of 36 patients.For the enhanced total parenteral nutrition group,total parenteral nutrition (TPN) had been given from three days before the operation,and for the control group,TPN was given from 1 day after the operation.The following items were observed,including serum total proteins,albumin level,pre-albumin level,transferrin level,as well as the time for exhausting by anus after the operation,the occurrence rate of eomplieatious,and the days for staying in hospital after the operation.Results The observed index of the enhanced group at the third day and the 12th day are all higher than those of the control group.The time for anus exhausting between the two groups did not show a significance in statistics.And the occurrence rate of complications and the days for staying in hospital after the operation in the enhanced group were less than those of the control group.Conclusions Giving TPN to the patients with malignant obstructive jaundice three days before the operation,will help the patients recover and reduce complications and days for staying in hospital.     

自我系统血糖监测对糖尿病病人血糖的影响

糖尿病(DM )是一种慢性代谢性疾病,由于体内胰岛素缺乏或相对缺乏,形成持续高血糖,继而导致各种并发症。有效地控制高血糖是防治DM慢性并发症和合并症的最关键措施。血糖监测对于调整治疗和防止低血糖发生至关重要,它是防治糖尿病的关键,但又常常不为病人重视。为了观察自我系统血糖监测对糖尿病病人血糖的影响,我们观察了5 2例门诊糖尿病病人自我系统血糖监测前后的血糖及糖基化血红蛋白(HbAlc)的变化。现将结果报告如下。1　资料与方法1.1　对象　2 0 0 3年3月选择在我院门诊就诊并按WHO诊断标准确诊为DM的病人5 2例,男3 0例,女2 2例…     

加强的全肠外营养支持应用于恶性梗阻性黄疸术后患者的效果

Objective To investigate the effect of enhanced total parenteral nutrition support to patients after accepting surgery operation for malignant obstructive jaundice.Methods Randomly,72 cases of patients with malignant obstructive jaundice having a body capacity score of ≤4 before the operation were divided into two groups,i.e.,the enhanced total parenteral nutrition group of 36 patients,and the control group of 36 patients.For the enhanced total parenteral nutrition group,total parenteral nutrition (TPN) had been given from three days before the operation,and for the control group,TPN was given from 1 day after the operation.The following items were observed,including serum total proteins,albumin level,pre-albumin level,transferrin level,as well as the time for exhausting by anus after the operation,the occurrence rate of eomplieatious,and the days for staying in hospital after the operation.Results The observed index of the enhanced group at the third day and the 12th day are all higher than those of the control group.The time for anus exhausting between the two groups did not show a significance in statistics.And the occurrence rate of complications and the days for staying in hospital after the operation in the enhanced group were less than those of the control group.Conclusions Giving TPN to the patients with malignant obstructive jaundice three days before the operation,will help the patients recover and reduce complications and days for staying in hospital.     

加强的全肠外营养支持应用于恶性梗阻性黄疸术后患者的效果

Objective To investigate the effect of enhanced total parenteral nutrition support to patients after accepting surgery operation for malignant obstructive jaundice.Methods Randomly,72 cases of patients with malignant obstructive jaundice having a body capacity score of ≤4 before the operation were divided into two groups,i.e.,the enhanced total parenteral nutrition group of 36 patients,and the control group of 36 patients.For the enhanced total parenteral nutrition group,total parenteral nutrition (TPN) had been given from three days before the operation,and for the control group,TPN was given from 1 day after the operation.The following items were observed,including serum total proteins,albumin level,pre-albumin level,transferrin level,as well as the time for exhausting by anus after the operation,the occurrence rate of eomplieatious,and the days for staying in hospital after the operation.Results The observed index of the enhanced group at the third day and the 12th day are all higher than those of the control group.The time for anus exhausting between the two groups did not show a significance in statistics.And the occurrence rate of complications and the days for staying in hospital after the operation in the enhanced group were less than those of the control group.Conclusions Giving TPN to the patients with malignant obstructive jaundice three days before the operation,will help the patients recover and reduce complications and days for staying in hospital.     

加强的全肠外营养支持应用于恶性梗阻性黄疸术后患者的效果

Objective To investigate the effect of enhanced total parenteral nutrition support to patients after accepting surgery operation for malignant obstructive jaundice.Methods Randomly,72 cases of patients with malignant obstructive jaundice having a body capacity score of ≤4 before the operation were divided into two groups,i.e.,the enhanced total parenteral nutrition group of 36 patients,and the control group of 36 patients.For the enhanced total parenteral nutrition group,total parenteral nutrition (TPN) had been given from three days before the operation,and for the control group,TPN was given from 1 day after the operation.The following items were observed,including serum total proteins,albumin level,pre-albumin level,transferrin level,as well as the time for exhausting by anus after the operation,the occurrence rate of eomplieatious,and the days for staying in hospital after the operation.Results The observed index of the enhanced group at the third day and the 12th day are all higher than those of the control group.The time for anus exhausting between the two groups did not show a significance in statistics.And the occurrence rate of complications and the days for staying in hospital after the operation in the enhanced group were less than those of the control group.Conclusions Giving TPN to the patients with malignant obstructive jaundice three days before the operation,will help the patients recover and reduce complications and days for staying in hospital.