两种强化降糖方案治疗2型糖尿病的临床分析

发布时间：2018-05-04 16:33

本文选题：胰岛素泵 + 胰岛素皮下注射　；参考：《重庆理工大学》2015年硕士论文

【摘要】：糖尿病(DM)是一种主要临床表现为糖类代谢紊乱继发蛋白质和脂肪代谢紊乱的常见慢性病,其病理生理基础是机体胰岛素分泌相对或绝对不足、胰岛素作用低下或者胰岛素抵抗,由遗传和环境因素共同作用。.随着近年人民生活水平提高、生活方式的改变,其发病率和患病率呈逐年明显上升趋势,日益成为威胁人类健康的世界性公共卫生问题。持续的高血糖及代谢紊乱状态可导致全身组织脏器(尤眼、肾、心血管及神经系统)慢性损害,而严重代谢紊乱者亦可引起酮症酸中毒和高渗昏迷等急性并发症,使得人民生活质量明显下降的同时并威胁着我们的生命。糖尿病是一个需要终身控制的疾患,有效预防及控制糖尿病及糖尿病并发症发生发展,具有极其重要意义。目前治疗糖尿病的综合治疗手段主要包括降糖、降压、调脂、抗凝、控制体重、改善生活方式等,其中降糖任务贯穿糖尿病患者生命始终。“降糖”不仅仅指将血糖降至正常,怎样更好、更平稳、更少副反应、更多收益来维持正常血糖状态显得更至关重要。降糖药物中胰岛素具有降糖效果好、保护胰岛功能的优点,是其他降糖药物不能替代的。胰岛素是胰岛β细胞功能低下或缺陷的最佳选择,包括1型糖尿病、部分胰岛分泌障碍口服降糖药物难以控制的2型糖尿病及合并某些特殊病情的血糖增高(如应激性高血糖,妊娠糖尿病,儿童糖尿病,并发急性代谢紊乱的2型糖尿病,围手术期的2型糖尿病,合并肺结核等营养不良因素的2型糖尿病,合并脑卒中、心力衰竭、肾功能衰竭等严重疾患的2型糖尿病等)。与常规胰岛素治疗方案相比,强化胰岛素治疗方案能更好模拟人胰岛素正常生理分泌模式,更有效预防糖尿病慢性并发症发生发展。强化治疗有两种方式:胰岛素泵治疗(CSII)和每日多次胰岛素注射(MSII)。其中近年对胰岛素泵方式的重要性越来越受到关注。研究目的:对CSII与MSII在2型糖尿病强化降糖中疗效差异进行对比,寻求一种让患者更受益的治疗方式。研究方法:将60例2型糖尿病患者随机分成两组,CSII组采用诺和灵#174;R胰岛素泵治疗,MSII组采用三餐前诺和灵#174;R和睡前诺和灵#174;N治疗。监测两组病人治疗前后全天血糖谱的变化,比较血糖达标所需要的时间、胰岛素用量和低血糖发生率等情况。研究结果:CSII组与MSII组相比,在血糖达标所需的时间、胰岛素用量及低血糖发生率等方面具有显著性差异(P0.05)。研究结论:CSII和MSII均能有效治疗2型糖尿病。其中,CSII能更好模拟生理性胰岛素分泌模式,控制血糖效果更好,达标时间短,胰岛素用量小,低血糖发生率低。CSII明显优于MSII,值得临床应用推广。
[Abstract]:Diabetes mellitus (DMN) is a common chronic disease with main clinical manifestations of protein and fat metabolism disorder secondary to glucose metabolism disorder. Its pathophysiological basis is relative or absolute insufficiency of insulin secretion, low insulin function or insulin resistance. By genetic and environmental factors. With the improvement of people's living standard and the change of life style in recent years, the incidence and prevalence rate of the disease have been increasing year by year, which has become a worldwide public health problem threatening human health. Persistent hyperglycemia and metabolic disorders can lead to chronic damage to systemic organs (especially eyes, kidneys, cardiovascular and nervous systems), while severe metabolic disorders can lead to acute complications such as ketoacidosis and hyperosmotic coma. So that the quality of life of the people at the same time a significant decline and threaten our lives. Diabetes mellitus is a disease that needs lifelong control. It is of great significance to prevent and control the occurrence and development of diabetes mellitus and its complications. At present, the comprehensive treatment of diabetes mainly includes reducing sugar, lowering blood pressure, regulating lipid, anticoagulant, controlling body weight, improving life style and so on. "hypoglycemia" is not just about lowering blood sugar to normal. It's even more important to be better, smoother, less side effects, and more revenue to maintain normal blood sugar. Insulin has good hypoglycemic effect in hypoglycemic drugs and can not be replaced by other hypoglycemic drugs because of its advantages of protecting islet function. Insulin is the best choice for islet 尾 cell dysfunction or deficiency, including type 1 diabetes, type 2 diabetes, which is difficult to control by oral hypoglycemic drugs, and hyperglycemia associated with specific conditions, such as stress hyperglycemia. Gestational diabetes, childhood diabetes, type 2 diabetes complicated with acute metabolic disorder, type 2 diabetes during perioperative period, type 2 diabetes with malnutrition such as tuberculosis, stroke, heart failure, Type 2 diabetes mellitus with severe renal failure and other diseases. Compared with conventional insulin therapy, intensive insulin therapy can better mimic the normal physiological secretion pattern of human insulin and prevent the development of diabetic chronic complications. Intensive therapy comes in two ways: insulin pump therapy (CSII) and multiple daily insulin injections (MS II). In recent years, more and more attention has been paid to the importance of insulin pump. Objective: to compare the efficacy of CSII and MSII in intensive hypoglycemia in type 2 diabetes mellitus. Methods: 60 patients with type 2 diabetes mellitus were randomly divided into two groups: CSII group treated with Novolin #174R insulin pump and MSII group treated with three-prandial Novolin #174R and bedtime Noir and #174N. The changes of blood glucose spectrum before and after treatment were monitored, and the time required for blood glucose to reach the standard, the amount of insulin and the incidence of hypoglycemia were compared between the two groups. Results compared with MSII group, there were significant differences in the time required for blood glucose standard, the amount of insulin and the incidence of hypoglycemia in the two groups (P 0.05). Conclusion both MSII and VCSII are effective in the treatment of type 2 diabetes. CSII can better simulate physiological insulin secretion model, control blood glucose effect better, meet the standard time is short, insulin dosage is small, low incidence of hypoglycemia. CSII is obviously superior to MSII.CSII is worthy of clinical application.
【学位授予单位】：重庆理工大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R587.1

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