不同剂量胰岛素治疗小儿糖尿病酮症酸中毒的效果比较(1)
[摘要] 目的 分析不同剂量胰岛素治疗小儿糖尿病酮症酸中毒(DKA)的效果。方法 以2012年1月—2017年12月间入该院治疗的24例DKA患儿为研究主体。分成A组和B组，各12例。A组给予小剂量胰岛素治疗，B組给予大剂量胰岛素治疗。对比治疗效果。 结果 A组的空腹血糖(FBG)与餐后2 h血糖(PBG)略低于B组，对比差异无统计学意义(P>0.05)；A组的血糖达标时间、酮体转阴时间与pH恢复时间均短于B组，对比差异有统计学意义(P<0.05)。A组的低血糖发生率低于B组(P<0.05)。治疗后，两组的生化指标均低于治疗前，对比差异有统计学意义(P<0.05)。 结论 为DKA患儿行小、大剂量胰岛素治疗的降糖效果均较佳，但小剂量胰岛素的治疗安全性更高，更具有推广价值。
[关键词] 不同剂量；胰岛素；小儿糖尿病酮症酸中毒
[中图分类号] R725 [文献标识码] A [文章编号] 1672-4062(2018)10(a)-0075-02
[Abstract] Objective To analyze the effect of different doses of insulin in treatment of children with diabetic ketoacidosis. Methods 24 cases of DKA children treated in our hospital from January 2012 to December 2017 were selected and divided into two groups with 12 cases in each， the group A used the small-dose insulin， while the group B used the large-dose insulin， and the treatment effect was compared between the two groups. Results The FBG and PBG in the group A were slightly lower than those in the group B， and the differences were not obvious(P>0.05)， and the blood glucose standard-reaching time， ketone body negative time and PH recovery time in the group A were shorter than those in the group B， and the differences were obvious，(P<0.05)， and the incidence rate of hypoglycemia in the group A was lower than that in the group B(P<0.05)， after treatment， the biochemical indicators of the two groups were lower than those before treatment， and the differences were obvious(P<0.05). Conclusion The hypoglycemic effect of large-dose and small-dose insulin for DKA children is better， but the treatment safety of small-dose insulin is higher， with promotion value.
[Key words] Different doses； Insulin； Children with diabetic ketoacidosis
DKA是临床儿科的高发病，其属于急性代谢并发症，发病机制为：在多种诱因下，糖尿病患儿出现胰岛素迅速下降情况，使其血糖明显升高，机体代谢功能严重紊乱，进而导致DKA[1]。其死亡率约为19%，需立即采取有效治疗。胰岛素注射是其常规疗法，但使用剂量不同，疗效也存有差异。研究中以2012年1月—2017年12月间入该院治疗的24例DKA患儿为研究主体，旨在探究不同剂量胰岛素治疗DKA患儿的效果，现报道如下。
1 资料与方法
1.1 一般资料
以该院治疗的24例DKA患儿为研究主体。经伦理委员会直接审查，且得到批准。随机分成A组和B组，各是12例。A组中，男7例，女5例；年龄范围是3～11岁，平均(5.98±0.42)岁；随机血糖为(24.22±0.13)mmol/L。B组中，男8例，女4例；年龄范围是2～12岁，平均(5.19±0.33)岁；随机血糖为(23.87±0.26)mmol/L。上述数据对比差异无统计学意义(P>0.05)，可比较。
1.2 方法
所有患儿均进行常规治疗，如补液扩容、抗感染和纠正水电解质失衡等。A组给予小剂量胰岛素(国药准字H11020548)治疗：剂量为0.05～0.10 U/(kg·h)，行静脉持续滴注治疗，滴速为1 mL/(kg·h)。B组给予大剂量胰岛素治疗：剂量为0.11～0.20 U/(kg·h)，行静脉持续滴注治疗，滴速为1 mL/(kg·h)。
1.3 观察指标
观察患者的血糖达标时间、FBG、PBG、酮体转阴时间和pH值恢复时间等临床指标；计算低血糖发生率；并记录患儿治疗前后的IL-6(白细胞介素-6)、IL-18、IL-12和TNF-α(肿瘤坏死因子-ɑ)变化情况。
1.4 统计方法, http://www.100md.com(冯荣学)
[关键词] 不同剂量；胰岛素；小儿糖尿病酮症酸中毒
[中图分类号] R725 [文献标识码] A [文章编号] 1672-4062(2018)10(a)-0075-02
[Abstract] Objective To analyze the effect of different doses of insulin in treatment of children with diabetic ketoacidosis. Methods 24 cases of DKA children treated in our hospital from January 2012 to December 2017 were selected and divided into two groups with 12 cases in each， the group A used the small-dose insulin， while the group B used the large-dose insulin， and the treatment effect was compared between the two groups. Results The FBG and PBG in the group A were slightly lower than those in the group B， and the differences were not obvious(P>0.05)， and the blood glucose standard-reaching time， ketone body negative time and PH recovery time in the group A were shorter than those in the group B， and the differences were obvious，(P<0.05)， and the incidence rate of hypoglycemia in the group A was lower than that in the group B(P<0.05)， after treatment， the biochemical indicators of the two groups were lower than those before treatment， and the differences were obvious(P<0.05). Conclusion The hypoglycemic effect of large-dose and small-dose insulin for DKA children is better， but the treatment safety of small-dose insulin is higher， with promotion value.
[Key words] Different doses； Insulin； Children with diabetic ketoacidosis
DKA是临床儿科的高发病，其属于急性代谢并发症，发病机制为：在多种诱因下，糖尿病患儿出现胰岛素迅速下降情况，使其血糖明显升高，机体代谢功能严重紊乱，进而导致DKA[1]。其死亡率约为19%，需立即采取有效治疗。胰岛素注射是其常规疗法，但使用剂量不同，疗效也存有差异。研究中以2012年1月—2017年12月间入该院治疗的24例DKA患儿为研究主体，旨在探究不同剂量胰岛素治疗DKA患儿的效果，现报道如下。
1 资料与方法
1.1 一般资料
以该院治疗的24例DKA患儿为研究主体。经伦理委员会直接审查，且得到批准。随机分成A组和B组，各是12例。A组中，男7例，女5例；年龄范围是3～11岁，平均(5.98±0.42)岁；随机血糖为(24.22±0.13)mmol/L。B组中，男8例，女4例；年龄范围是2～12岁，平均(5.19±0.33)岁；随机血糖为(23.87±0.26)mmol/L。上述数据对比差异无统计学意义(P>0.05)，可比较。
1.2 方法
所有患儿均进行常规治疗，如补液扩容、抗感染和纠正水电解质失衡等。A组给予小剂量胰岛素(国药准字H11020548)治疗：剂量为0.05～0.10 U/(kg·h)，行静脉持续滴注治疗，滴速为1 mL/(kg·h)。B组给予大剂量胰岛素治疗：剂量为0.11～0.20 U/(kg·h)，行静脉持续滴注治疗，滴速为1 mL/(kg·h)。
1.3 观察指标
观察患者的血糖达标时间、FBG、PBG、酮体转阴时间和pH值恢复时间等临床指标；计算低血糖发生率；并记录患儿治疗前后的IL-6(白细胞介素-6)、IL-18、IL-12和TNF-α(肿瘤坏死因子-ɑ)变化情况。
1.4 统计方法, http://www.100md.com(冯荣学)