摘要
目的 研究乌司他丁联合胰岛素泵对糖尿病酮症酸中毒(DKA)患者pH值纠正时间及血清硫胺素浓度的影响.方法 前瞻性选取2020年1月至2022年12月北京市大兴区人民医院收治的DKA患者86例,依据随机数字表法分为联合组(n=43)、对照组(n=43).对照组行常规治疗+胰岛素泵治疗,联合组行常规治疗+胰岛素泵+乌司他丁治疗.观察两组治疗前及治疗2周后血糖指标[糖化血红蛋白(HbA1c)、空腹血糖(FPG)、餐后2 h血糖(2 h PG)]、血清硫胺素、乳酸及二氧化碳结合力(CO2CP)水平.比较两组的胰岛素用量、血糖稳定时间、血pH值纠正时间、血酮体转阴时间、尿酮体转阴时间等临床指标,比较临床疗效及不良反应发生情况.结果 治疗2周后,联合组HbA1c、FPG、2 h PG 分别为(6.48±0.67)％、(8.20±0.84)mmol/L、(8.43±0.86)mmol/L,均低于对照组[(7.38±0.76)％]、(10.65±1.25)mmol/L、(11.39±1.32)mmol/L],差异均有统计学意义(P＜0.05).治疗2周后,联合组血清硫胺素浓度为(16.95±1.86)nmol/L,高于对照组[(13.68±1.52)nmol/L],血清乳酸及 CO2CP 浓度分别为(3.09±0.32)、(3.42±0.36)mmol/L,均低于对照组[(4.87±0.5)、(4.39±0.45)mmol/L],差异均有统计学意义(P＜0.05).联合组胰岛素用量、血糖稳定时间、血pH值纠正时间、血酮体转阴时间、尿酮体转阴时间分别为(0.83±0.09)kg·h、(4.63±0.48)h、(35.08±3.76)h、(25.28±2.79)h、(8.48±0.87)h,均小(短)于对照组[(0.92±0.11)kg·h、(5.76±0.59)h、(42.75±4.63)h、(33.07±3.64)h、(12.96±1.51)h],差异均有统计学意义(P＜0.05).联合组治疗的总有效率为90.70％,高于对照组(69.77％),差异有统计学意义(P＜0.05).两组不良反应发生率比较(4.65％vs.9.30％),差异无统计学意义(P＞0.05).结论 乌司他丁联合胰岛素泵可有效控制DKA患者血糖,缩短其pH值纠正时间,提高患者血清硫胺素浓度,疗效显著,安全性高,值得临床推广应用.
Abstract
Objective To study the effects of ulinastatin combined with insulin pump on pH correction time and serum thiamine concen-tration in patients with diabetic ketoacidosis(DKA).Methods A total of 86 DKA patients treated in Beijing Daxing District People's Hospital from January 2020 to December 2022 were prospectively selected and divided into the combination group(n=43)and the control group(n=43)according to random number table method.The control group received conventional treatment+insulin pump treatment,and the combination group received conventional treatment+insulin pump+ulinastatin treatment.The blood glucose indexes[glycosylated hemoglobin(HbA1c),fast-ing blood glucose(FPG),2 h postprandial blood glucose(2 h PG)],serum thiamine,lactic acid and carbon dioxide combining power(CO2CP)before and two weeks after treatment in the two groups were observed.Clinical indexes such as the insulin dosage,blood glucose stability time,blood pH correction time,blood ketone body negative time,urine ketone body negative time were compared;the clinical efficacy and the adverse reaction of the two groups were compared.Results At two weeks after treatment,HbA1c,FPG and 2 h PG in the combination group were(6.48±0.67)％,(8.20±0.84)mmol/L,(8.43±0.86)mmol/L,respectively,which were lower than those in the control group[(7.38±0.76)％,(10.65±1.25)mmol/L,(11.39±1.32)mmol/L],the differences were statistically significant(P＜0.05).At two weeks after treatment,serum thiamine concentration in combination group was(16.95±1.86)nmol/L,which was higher than that in control group[(13.68±1.52)nmol/L],serum lactate and CO2CP concentrations were(3.09±0.32),(3.42±0.36)mmol/L,respectively,which were lower than those in control group[(4.87±0.5),(4.39±0.45)mmol/L],the differences were statistically significant(P＜0.05).The insulin dosage,blood glucose stabilization time,blood pH correction time,blood ketone body negative time,urine ketone body negative time in combination group were(0.83±0.09)kg·h,(4.63±0.48)h,(35.08±3.76)h,(25.28±2.79)h,(8.48±0.87)h,respectively,which were lower than that in control group[(0.92±0.11)kg·h,(5.76±0.59)h,(42.75±4.63)h,(33.07±3.64)h,(12.96±1.51)h],the differences were statistically significant(P＜0.05).The total effective rate of combination group was higher than that of control group(90.70％vs.69.77％),the difference was statistically significant(P＜0.05).There was no statistically significant difference in the incidence of adverse re-actions between the two groups(4.65％vs.9.30％)(P＞0.05).Conclusion Ulinastatin combined with insulin pump can effectively control the blood glucose of DKA patients,shorten the correction time of pH value,and improve the serum thiamine concentration of patients,with signifi-cant efficacy and high safety.
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