摘要
目的通过对单侧股骨颈骨折合并新发2型糖尿病患者的短期强化降糖治疗,比较持续皮下胰岛素泵输注(CSII)与长效+速效胰岛素类似多次皮下注射(MSII)两种治疗方式的疗效及医疗费用。方法随机将64例单侧股骨颈骨折合并新发2型糖尿病患者分为两组,分别给予CSII治疗(33例)和MSII治疗(31例)对血糖达标时间、胰岛素使用剂量、手术并发症、住院费用、住院时间等指标进行比较。结果 CSII组的空腹血糖达标时间(TTF)、餐后血糖达标时间(TTP)、空腹及餐后同时达标时间(TTB)都较MSII短(46.18±25.0h vs 88.9±41.0h、64.1±25.6h vs 103.9±46.9h、66.2±24.7h vs 115.5±72.1h,P<0.05);CSII组的达标时胰岛素总量、基础胰岛素用量、餐时胰岛素用量也均较MDII组少(0.65±0.11 IU/kg vs 0.80±0.19 IU/kg、0.32±0.07 IU/kg vs 0.37±0.12 IU/kg、0.33±0.06 IU/kg vs 0.44±0.10 IU/kg,P<0.05)。平均每日基础胰岛素增减剂量CSII组较MSII组大[0.08±0.07IU/(kg·d)vs 0.05±0.04IU/(kg·d),P<0.05],平均每日餐时胰岛素增减剂量CSII组较MSII组小[0.01±0.03 U/(kg·d)vs 0.03±0.03 U/(kg·d),P<0.05]。两组间住院总费用、手术费用及非手术费用两者均无差别,而CSII组较MSII组住院时间短、术后低蛋白血症减少(13.6±2.7天vs 15.7±3.4天,1例vs 6例,P<0.05)。MSII组TTB影响因素是达标基础量、基础步长(β值为0.875、-0.677,P<0.05),非手术费用的影响因素是住院时间、下肢深静脉血栓、术后低蛋白血症(β值为0.445、0.392、0.389,P<0.05),住院天数的影响因素是术后低蛋白血症、TTB(β值为0.400、0.288,t值为3.596、2.101,P<0.05);CSII组TTB影响因素是达标餐时量、餐时步长(β值为0.763、-0.896,P<0.05),非手术费用的影响因素是住院时间、下肢深静脉血栓(β值为0.453、0.372,P<0.05),住院天数的影响因素是TTB(β=0.450,P<0.05)。结论在单侧股骨颈骨折合并新发2型糖尿病患者的术前血糖控制方面,持续皮下胰岛素泵输注疗法优于长效+速效胰岛素类似多次皮下注射疗法。住院费用两者相同,但持续皮下胰岛素泵输注疗法可能通过减少住院时间进一步节省社会资源。
Objective To clarify the efficacy and medical costs of two different perioperative insulin treatment protocol, continuous subcutaneous insulin injection （CSⅡ） and multiple subcutaneous insulin injections （MSⅡ） in patients with unilateral femoral neck fracture complicated with newly-diagnosed type 2 diabetes mellitus （T2DM）.Methods A total of 64 subjects were enrolled in this study and they were randomly divided into two groups, CSⅡ and MSⅡ. CSⅡ group （n=33） were treated with rapid-acting insulin analog while MSⅡ group （n=31） were treated with long-acting and rapid-acting analog. The time of reaching glucose target for perioperative requirements, the dosages of insulin, the incidence of perioperative complications, the length of hospital stay and the medical cost of the two groups were analyzed.Results Compared with MSⅡ group, CSⅡ group had shorter time to achieve the therapeutic target of fasting glucose （TTF）, of postprandial glucose （TTP） and of the both （TTB） （CSⅡ vs MSⅡ, 46.18±25.0h vs 88.9±41.0h; 64.1±25.6h vs 103.9±46.9h; 66.2±24.7h vs 115.5±72.1h, P〈0.05）. The dosages of total, basal and mealtime insulin of CSⅡ group were smaller than that of MSⅡ group when glycemic target achieved （0.65±0.11IU/kg vs 0.80±0.19IU/kg; 0.32±0.07IU/kg vs 0.37±0.12IU/kg; 0.33±0.06IU/kg vs 0.44±0.10IU/kg, P〈0.05）. The average change of daily basal insulin dosage of CSⅡ was greater than that of MSⅡ[0.08±0.07IU/（kg·d） vs 0.05±0.04IU/（kg·d）, P〈0.05], while the average change of daily mealtime insulin dosage of CSⅡ was smaller than that of MSⅡ[0.01±0.03IU/（kg·d） vs 0.03±0.03IU/（kg·d）, P〈0.05]. Although there were no significant difference in the total medical cost, in the operation cost and in the non-operative cost between the two groups, the CSⅡ group had shorter hospital stay and lower incidence of postoperative hypoalbuminemia （13.6±2.7 vs 15.7±3.4, P〈0.05）.Conclusion With regard to the management of perioperative hyperglycemia in patients with unilateral femoral neck fracture, CSⅡ was superior to MSⅡ. Although the medical cost of the two protocols were similar, protocol of CSⅡ might further save social resources by reducing the length of hospital stay.
出处
《医学研究杂志》
2017年第12期32-36,共5页
Journal of Medical Research
基金
北京市医院管理局"青苗"计划项目(QML20160404)
关键词
瞎尿病
骨折围术期
胰岛素泵
胰岛素类似物
住院费用
Diabetes mellitus
Fracture perioperative period
Continuous subcutaneous insulin injection
Insulin analogue
Medical cost
