中国血液净化

›› 2004, Vol. 3 ›› Issue (5): 243-246.

• 论著 • 上一篇    下一篇

糖尿病腹膜透析患者胰岛素治疗方案探讨

陈孟华 甘红兵 董 捷 汪 涛   

  1. 100034 北京，北京大学第一医院肾内科
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2004-05-12 发布日期:2004-05-12

  • Received:1900-01-01 Revised:1900-01-01 Online:2004-05-12 Published:2004-05-12

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摘要： 目的 探讨糖尿病腹膜透析（ CAPD）患者合理的胰岛素应用方法。方法 采用横断面研究方法调查所有接受CAPD治疗至少6个月以上的糖尿病肾病患者的胰岛素使用方案及血糖控制情况。并在横断面研究的基础上，动态观察24例新收的糖尿病CAPD患者透析前、后胰岛素的使用方法、剂量调整方案及血糖控制情况。结果 2002年6月至2002年12月间共25例2型糖尿病CAPD患者，其中腹腔内注射胰岛素（IP）6人，皮下注射胰岛素（SC）9人，腹腔和皮下联合应用（IP+SC）7人。①空腹血糖、糖化血红蛋白、透析液糖总负荷量、透析液平均糖浓度、透析剂量在IP、SC、IP+SC三组间差异均无显著性, ( P >0.05)；②与 IP及IP+ SC组相比，SC组胰岛素用量明显减少， (P<0.05)；③腹膜炎的总发生率为1次/每15患者月，明显高于同期非糖尿病腹膜透析患者的腹膜炎发生率(1次/每48患者月)，(P < 0.01)；④动态观察24例新收的糖尿病 CAPD患者，胰岛素剂量较透析前平均增加了(0.33±0.23)倍。透析后调整的胰岛素实际增加量与理论预测增加量差异无显著性，（P>0.05）。患者血糖控制良好，平均为 (5.81±1.22) mmol/L。结论 皮下注射胰岛素是有效控制糖尿病CAPD患者血糖水平的适当途径。腹膜透析后，可在原有皮下应用胰岛素方案的基础上，参照糖吸收量计算需增加的胰岛素用量适当增减胰岛素，能有效控制血糖。

关键词: 腹膜透析, 糖尿病, 胰岛素

Abstract:

Objective To study the optimal insulin therapy in diabetic peritoneal dialysis patients. Methods In a cross-sectional study, 25 type 2 diabetic patients treated with peritoneal dialysis for at least 6 months were investigated. We reviewed their dialysis prescription, insulin therapy regimen and blood glucose control. We also retrospectively studied the changes of insulin doses and glycemic control in 24 new diabetic peritoneal dialysis patients. Results In the cross-sectional study, 23 of the 25 patients used insulin, 6 cases by intraperitoneally（IP）, 9 cases by subcutaneously（SC）, and 7 cases via the combined subcutaneous and intraperitoneal routes（IP+SC）. There were no significant differences in the fasting blood glucose, glycosylated hemoglobin, dialysate glucose concentrations, dialysate glucose load, dialysate doses among the three groups, whereas the insulin doses was significantly reduced in SC group as compared with the IP and IP+SC group (P<0.05). The peritonitis rate was higher in diabetics patients (1/15 per patient month) as compared to nondiabetic patients (1/48 per patient month) (P<0.01). After starting peritoneal dialysis in the 24 new patients, the insulin dosage was increased(0.33±0.23) times as compared to pre-dialysis insulin dose. There were no differences between practical and theoretical increase in insulin doses (P>0.05). Conclusion Our data suggest that subcutaneous insulin administration in peritoneal dialysis patients is more economic and convenience and is effective in blood glucose control. 

Key words: Diabetics, Insulin

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