持续皮下输注速效胰岛素类似物治疗急诊糖尿病酮症酸中毒的临床效果

谢永洪

[摘要] 目的 探讨持续皮下输注速效胰岛素类似物在急诊糖尿病酮症酸中毒治疗中的作用。方法 选取90例该院在2018年6月—2019年6月间收治的糖尿病酮症酸中毒患者进行研究，按照入院先后顺序分成对照组与观察组。分别予以胰岛素静脉滴注和持续皮下输注速效胰岛素类似物方案，比较治疗效果。结果 观察组血糖值和糖化血红蛋白、胰岛素用量、并发症发生率低于对照组，血糖控制时间和酮症酸中毒症状消失时间短于对照组（P<0.05）。结论 予以糖尿病酮症酸中毒患者持续皮下输注速效胰岛素类似物可提高疾病治疗效果，减少低血糖风险。

[关键词] 持续皮下输注;速效胰岛素类似物;糖尿病酮症酸中毒;控糖效果;并发症

[中图分类号] R587.1          [文献标识码] A          [文章编号] 1672-4062（2020）06（a）-0191-03

[Abstract] Objective To investigate the role of continuous subcutaneous infusion of fast-acting insulin analogue in the treatment of emergency diabetic ketoacidosis. Methods Ninety patients with diabetic ketoacidosis admitted to the hospital from June 2018 to June 2019 were selected for study， and were divided into a control group and an observation group according to the order of admission. Intravenous insulin infusion and continuous subcutaneous infusion of fast-acting insulin analogs were given to compare treatment effects. Results The blood glucose level， glycated hemoglobin， insulin dosage， and incidence of complications in the observation group were lower than those in the control group， and the time for blood glucose control and the disappearance of symptoms of ketoacidosis were shorter than those in the control group（P<0.05）. Conclusion Subcutaneous infusion of fast-acting insulin analogues can improve the treatment effect of the disease， reduce the risk of hypoglycemia.

[Key words] Continuous subcutaneous infusion; Fast-acting insulin analogs; Diabetic ketoacidosis; Glucose control effect; Complications

糖尿病酮癥酸中毒是糖尿病患者较为常见的并发症之一，多由胰岛素水平不足、生殖激素水平异常所致，其病理表现为高血糖、高血酮、水电解质紊乱、代谢性酸中毒等，疾病发展过程中可有恶心、呕吐、食欲不振等表现，特别是Ⅰ型糖尿病患者可同时伴随急性腹痛、腹肌紧张、肠鸣音减弱等，严重者可出现脱水、意识障碍、昏迷等情况，对患者生命安全构成威胁[1]。胰岛素皮下注射是该疾病较为常用的方案，但具体应用时可导致低血糖，控糖效果不甚理想。胰岛素类似物也被称作时餐时胰岛素，指的是可修饰胰岛素结构、模拟胰岛素正常分泌和及其正常生理功能的物质，通常被用于需要胰岛素治疗的糖尿病中，见效快、作用持续时间短，可迅速将血糖控制在正常范围，能同时降低血红蛋白水平，出现低血糖的风险小，也利于糖尿病患者模拟血糖水平正常者生理状态下的胰岛素代谢过程[2]。……