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目的探讨糖尿病酮症酸中毒(diabetic ketoacidosis,DKA)患者胰岛素微量泵泵注的起始剂量,及其对1h后血糖下降值(decreased blood glucose value after 1h,△1hBG)有效率的影响。方法 DKA患者82例,其中1型糖尿病(type 1diabetes mellitus,T1DM)患者26例(T1DM组),2型糖尿病(type 2diabetes mellitus,T2DM)患者56例(T2DM组),均给予微量泵泵注胰岛素治疗;依据第1小时胰岛素起始剂量中位数,将82例患者分为高泵速组、低泵速组;胰岛素治疗7~10d后,测定T2DM组患者空腹C肽、餐后2hC肽水平,依据空腹C肽与餐后2hC肽之和的中位数,将T2DM组患者分为2组;比较各组一般资料及入院时血糖、胰岛素起始剂量、△1hBG及其有效率。结果胰岛素起始剂量中位数为0.043 478u/(kg·h);起始剂量≥0.043 478u/(kg·h)41例为高泵速组,<0.043 478u/(kg·h)41例为低泵速组,2组年龄、性别比例、体质量指数、病程比较差异均无统计学意义(P>0.05);高泵速组初始血糖[(29.48±7.92)mmol/L]、胰岛素起始剂量[(0.068±0.019)u/(kg·h)]、△1hBG[(3.57±1.99)mmol/L]高于低泵速组[(19.73±5.25)mmol/L、(0.029±0.012)u/(kg·h)、(2.27±1.49)mmol/L](P<0.05);高泵速组△1hBG有效率(65.9%)与低泵速组(46.3%)比较差异无统计学意义(P>0.05);T2DM组空腹C肽与餐后2hC肽之和中位数为0.267nmol/L,C肽≥0.267nmol/L 28例为高C肽组,C肽<0.267nmol/L 28例为低C肽组,高、低C肽组年龄较T1DM组大,病程较T1DM组长(P<0.05);高C肽组年龄较低C肽组小,病程较低C肽组短(P<0.05),体质量指数高于低C肽组和T1DM组(P<0.05);T1DM组、高C肽组、低C肽组初始血糖、胰岛素起始剂量比较差异无统计学意义(P>0.05),但高C肽组△1hBG[(2.35±1.86)mmol/L]低于低C肽组[(3.58±2.07)mmol/L](P<0.05);TIDM组、高C肽组、低C肽组△1hBG有效率分别为50.0%、46.4%、71.4%,3组比较差异无统计学意义(P>0.05);但3组△1hBG>4.2mmol/L比率(26.9%、17.9%、57.1%)比较差异有统计学意义,且低C肽组高于高C肽组(P<0.05)。结论胰岛素泵注起始剂量0.05u/(kg·h)可有效降低成人DKA患者血糖水平,临床可结合患者血糖、年龄、病程、体质量指数进一步调整胰岛素泵注剂量。
Objective To investigate the initial dose of insulin pump for diabetic ketoacidosis (DKA) and its effect on the efficiency of decreased blood glucose value after 1 hour (△ 1hBG). Methods A total of 82 patients with DKA were enrolled in this study. Twenty-six patients (T1DM group) with type 1 diabetes mellitus (T1DM) and 56 patients (T2DM group) with type 2 diabetes mellitus (T2DM) 82 patients were divided into high-pumping rate group and low-pumping rate group according to median of first-hour starting dose of insulin. After 7 to 10 days of insulin treatment, fasting C-peptide and postprandial 2-h peptide level According to the median of the sum of fasting C-peptide and postprandial 2-h peptide, the patients with T2DM were divided into two groups. The general data of each group and the initial blood glucose, initial insulin dosage, △ 1hBG and their effective rate were compared. Results The median initial dose of insulin was 0.043 478u / (kg · h); the initial dose was 0.043 478u / (kg · h), 41 cases were high pump speed group, and <0.043 478u / (kg · h) There was no significant difference in age, sex ratio, body mass index and course of disease between the two groups (P> 0.05); the initial blood glucose of high pump group [(29.48 ± 7.92) mmol / L] The dose of [(0.068 ± 0.019) u / (kg · h)] and △ 1hBG [(3.57 ± 1.99) mmol / L] were significantly higher than those in the low pump group [(19.73 ± 5.25) mmol / L, /(kg.h)(2.27 ± 1.49)mmol/L](P<0.05). There was no significant difference between the high-pump group and the low-pump group (65.9% vs 46.3%) (P <0.05) P <0.05). The median of statistic difference between fasting C-peptide and postprandial 2-h peptide in T2DM group was 0.267nmol / L, C-peptide≥0.267nmol / L in 28cases with high C peptide group, C peptide <0.267nmol / L in 28cases For the low C peptide group, the age of the high and low C peptide groups was larger than that of the T1DM group (P <0.05), and the age of the high C peptide group was smaller than that of the T1DM group (P <0.05). The body mass index was higher than that of low-C peptide group and T1DM group (P <0.05). There was no significant difference in initial blood glucose and initial insulin dosage between T1DM group, high C peptide group and low C peptide group (P> 0.05), but high C peptide group △ 1 hBG [(2.35 ± 1.86) mmol / L] was lower than that of low C peptide group [(3.58 ± 2.07) mmol / L] (P <0.05). The effective rates of △ 1hBG in TIDM group, high C peptide group and low C peptide group were (50%, 46.4%, 71.4% respectively). There was no significant difference among the three groups (P> 0.05). However, the difference of △ 1hBG> 4.2mmol / L among the three groups was statistically significant (26.9%, 17.9%, 57.1% Significance, and low C-peptide group was higher than high C peptide group (P <0.05). Conclusion Insulin pump initial dose of 0.05u / (kg · h) can effectively reduce the blood sugar level in adult patients with DKA. The dose of insulin pump can be further adjusted according to the patients’ blood glucose, age, course of disease and body mass index.