持续皮下胰岛素注射在糖尿病酮症酸中毒早期应用的合理性探讨

目的:比较持续皮下胰岛素注射(CSⅡ)和持续静脉胰岛素输注(CVⅡ)在合并糖尿病酮症酸中毒(DKA)患者早期治疗中的有效性和合理性.方法:比较两组血糖达标时间、胰岛素用量、酮体和酸中毒纠正的时间、低血糖发生率及治疗前5 d血糖水平波动情况.结果:两组血糖达标的时间类似,但CSⅡ组前5 d血糖稳定于靶目标值(11.1±2.0 mmol/L)比例更高,且血糖的波动更小,前3 d胰岛素的用量更小(P均＜0.05);两组在酮体转阴、酸中毒纠正的时间以及低血糖的发生上无显著性差异(P均＞0.05).结论:CSⅡ和CVⅡ都能纠正DKA早期的代谢紊乱,但CSⅡ能使血糖更平稳、波动更小,临床使用须根据病情而定.

Rational Approach of Continuous Subcutaneous Insulin Infusion in Patients With Early Diabetic Ketoacidosis

Objective: To compare the clinical effects and rationality of continuous subcutaneous insulin infusion (CSII) and continuous intravenous insulin infusion (CVII) in early diabetic ketoacidosis (DKA). Methods: Blood glucose levels, days needed for achieving good control, insulin dosage, the time for disappearance of acetone bodies and correction of acidosis and hypoglycemic episodes were compared in both groups. Results: Both groups reached the target blood glucose in the same average duration, but the percentage of the blood glucose within the target range in CSII group was higher than that in CVII group in the first 5 days of treatment, and the insulin dosage was lower in CSII group (P<0.05); the time for disappearance of acetone bodies, correction of acidosis and the incidence of hypoglycemia did not differ between the two groups (P>0.05). Conclusion: In the early stage of DKA, both intensive therapy by CSII or CVII achieved excellent correction of the metabolic disorder, but the fluctuation was less in CSII group than that in CVII group, which one is more reasonable should according to the patient's clinical setting .