两种胰岛素治疗方案对2型糖尿病合并骨折患者围手术期效果的回顾性比较研究

摘要

目的 回顾性分析比较2型糖尿病患者骨折围手术期两种强化胰岛素治疗方案的疗效.方法 将301例2型糖尿病合并骨折患者按胰岛素治疗方案分为Ⅰ、Ⅱ二组.Ⅰ组201例,三餐前30min皮下注射优泌林R和晚10:00皮下注射优泌林N;Ⅱ组100例,三餐前30 min皮下注射优泌林R、早餐前30 min和晚10:00皮下注射优泌林N.比较两组患者术前及术后血糖控制水平,探讨影响术前血糖达标时间的因素.结果 术前血糖达标时间Ⅰ组(8.7±3.2)d,Ⅱ组(6.9±2.5)d(P＜o,01);Ⅱ组术后血糖控制更好;影响术前血糖达标时间的因素有:短效与中效胰岛素的比例、HbA1c和入院空腹血糖水平.结论 在优泌林R三餐前注射的基础上加注优泌林N时,睡前与早餐前一日二次的疗法比单一睡前加注的疗法,对患者术前血糖达标更为有效.%Objective We retrospectively compare the therapeutic effect between two subcutaneous insulin regimens in type 2 diabetes mellitus (T2DM) patients with the fractures during the perioperative period. Methods The 301 patients with T2DM plus fractures were divided into two groups: groups Ⅰ (n=201) receiving regular insulin three times a day before meals+NPH insulin at bedtime and group Ⅱ (n=100) receiving regular insulin three times a day+NPH insulin twice daily. The difference in glucose target arrival time and associated factors were analyzed, and glucose control levels were observed.Results The average time achieving satisfactory BG level was (8. 7 ± 3. 2)days and (6. 9 ± 2. 5)days for group Ⅰ and Ⅱ respectively(P＜0. 01). Binary logistics regression showed that the time of achieving BG level was associated with fasting glucose(FPG), HbA1c and the proportion of the regular insulin and the NPH insulin. Conclusions The results indicate that insulin injection five times a day can shorten the time of achieving desired BG level The time of achieving satisfactory BG level is associated with fasting glucose level, HbA1c and the ratio of the dose of regular insulin and NPH.