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目的观察糖尿病酮症酸中毒(DKA)患者应用胰岛素泵治疗与小剂量静脉持续注射胰岛素治疗前后血清IL-6和TNF-α及相关临床指标的变化。方法随机将78例DKA患者分为试验组(胰岛素泵治疗组)和对照组(常规小剂量静脉持续注射胰岛素治疗组),并分别观察胰岛素治疗后两组血清IL-6和TNF-α的变化以及血糖、尿糖、尿酮体、血β-羟丁酸、胰岛素用量、低血糖发生率等临床指标。结果经胰岛素强化治疗后,两组IL-6和TNF-α均逐渐下降,试验组出现效应更早,且效果优于对照组(P<0.05);发病第1 d和7 d,两组间血糖值在各时间点差异均无统计学意义(P>0.05),而发病第2 d,试验组空腹血糖低于对照组,凌晨血糖高于对照组,差异有统计学意义(P<0.05);试验组尿酮体转阴时间、β-羟丁酸恢复正常时间、平均每日胰岛素使用量和低血糖反应发生率均明显优于对照组,差异有统计学意义(P<0.05)。结论胰岛素泵治疗DKA优于常规小剂量静脉持续注射胰岛素治疗,不仅与其血糖控制平稳,恢复快,副作用较小有关,还和有效降低炎症因子水平有关。
Objective To observe the changes of serum IL-6 and TNF-α levels and related clinical indexes in patients with diabetic ketoacidosis (DKA) before and after low-dose intravenous infusion of insulin pump. Methods Seventy-eight patients with DKA were randomly divided into experimental group (insulin pump treatment group) and control group (conventional low-dose intravenous insulin infusion group), and the changes of serum IL-6 and TNF-α And blood glucose, urine sugar, urine ketone body, blood β-hydroxybutyrate, insulin dosage, the incidence of hypoglycemia and other clinical indicators. Results After intensive insulin therapy, the levels of IL-6 and TNF-α decreased gradually in both groups, and the effect of the experimental group was earlier than that of the control group (P <0.05). On the 1st and 7th days of the onset, There was no significant difference in blood glucose at each time point (P> 0.05). On the 2nd day after the onset of disease, the fasting blood glucose in the experimental group was lower than that in the control group, and the blood glucose in the early morning was higher than that in the control group (P <0.05) ; Test group, urinary ketone body turn over time, β-hydroxybutyrate recovery time, the average daily use of insulin and hypoglycemic response were significantly better than the control group, the difference was statistically significant (P <0.05). Conclusion Insulin pump treatment of DKA is superior to conventional low-dose intravenous insulin injections, which is not only related to stable and fast recovery of blood glucose, but also to less side effects. It is also related to reducing the level of inflammatory cytokines.