Cambridge Intestinal Failure and Transplant, Addenbrooke's Hospital, Cambridge, United Kingdom.
Institute of Metabolic Medicine, Addenbrooke's Hospital, Cambridge, United Kingdom.
JPEN J Parenter Enteral Nutr. 2018 Jul;42(5):846-854. doi: 10.1177/0148607117722750. Epub 2017 Dec 15.
Administration of parenteral nutrition (PN) may result in hyperglycemia in patients with preexisting diabetes or disease-related insulin resistance, and it can be associated with increased rates of complications. Treatment requires insulin therapy. Insulin can be administered subcutaneously, intravenously via a variable rate sliding scale, or by adding it directly to the PN. The last method is a potentially attractive technique for a number of reasons-it could deliver the insulin intravenously at a steady rate alongside carbohydrates, and in malnourished patients with little subcutaneous tissue, it may prevent the need for frequent insulin injections. Despite such potential advantages, the addition of insulin to PN remains controversial, largely with respect to the bioavailability of insulin in PN and resultant concerns of the risk of hypoglycemia. There is a paucity of long-term quality controlled studies to address this question. The available literature suggests that, at least in the short term, insulin addition to PN can achieve reasonable glycemic control with low rates of hypoglycemia, and the technique compares favorably with the use of long-acting insulin preparations. This literature review finds a wide range of values reported for insulin availability via PN, ranging from 44% to 95% depending on the type of PN container material used and the presence of added vitamins and trace elements. Few studies looking at glycemic control among patients receiving home PN were found, and larger prospective trials are needed to assess the efficacy and safety of this technique in this patient group.
肠外营养（PN）的管理可能导致原有糖尿病或与疾病相关的胰岛素抵抗患者发生高血糖，并且可能与并发症发生率增加相关。治疗需要胰岛素治疗。胰岛素可以皮下给药、通过可变速率滑动量表静脉内给药，或直接添加到 PN 中给药。最后一种方法由于多种原因是一种潜在有吸引力的技术 - 它可以在静脉内以稳定的速度与碳水化合物一起输送胰岛素，并且在营养不足且皮下组织很少的患者中，它可能避免需要频繁注射胰岛素。尽管存在这些潜在优势，但 PN 中添加胰岛素仍然存在争议，主要涉及胰岛素在 PN 中的生物利用度以及由此产生的低血糖风险的担忧。缺乏长期质量控制研究来解决这个问题。现有文献表明，至少在短期内，PN 中添加胰岛素可以实现合理的血糖控制，低血糖发生率低，并且该技术与长效胰岛素制剂的使用相比具有优势。这项文献综述发现，通过 PN 报告的胰岛素可用性值范围很广，从 44%到 95%不等，具体取决于 PN 容器材料的类型以及添加的维生素和微量元素。发现很少有研究关注接受家庭 PN 的患者的血糖控制情况，因此需要更大规模的前瞻性试验来评估该技术在该患者群体中的疗效和安全性。
