Anesthesiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Endocrinology and Diabetology, Medical University of Graz, Graz, Austria.
BMJ Open Diabetes Res Care. 2019 Dec 8;7(1):e000881. doi: 10.1136/bmjdrc-2019-000881. eCollection 2019.
This study investigated the effects of the inflammatory tissue response (ITR) to an insulin infusion set (IIS) on insulin bolus spread over wear time, as well as the effect of cannula insertion angle on the ITR, bolus shape, and pump tubing pressure.
Angled or straight IISs were inserted every other day for 14 days into the subcutaneous tissue of 11 swine and insulin was delivered continuously. Prior to euthanasia, a 70 µL bolus of insulin/X-ray contrast agent was infused while recording a pressure profile (peak tubing pressure, p; area under the pressure curve, AUC), followed by the excision of the tissue-catheter specimen. Bolus surface area (SA) and volume (V) were assessed via micro-CT. Tissue was stained to analyze total area of inflammation (TAI) and inflammatory layer thickness (ILT) surrounding the cannula.
A bolus delivered through an angled IIS had a larger mean SA than a bolus delivered through a straight cannula (314.0±84.2 mm vs 229.0±99.7 mm, p<0.001) and a larger volume (198.7±66.9 mm vs 145.0±65.9 mm, p=0.001). Both decreased significantly over wear time, independent of angle. There was a significant difference in TAI (angled, 9.1±4.0 mm vs straight, 14.3±8.6 mm, p<0.001) and ILT (angled, 0.7±0.4 vs straight, 1.2±0.7 mm, p<0.001). p (p=0.005) and AUC (p=0.014) were lower using angled IIS. As ILT increased, p increased, while SA and V decreased.
The progression of the ITR directly affected bolus shape and tubing pressure. Although straight insertion is clinically preferred, our data suggest that an angled IIS elicits lower grades of ITR and delivers a bolus with lower tubing pressure and greater SA and V. The subcutaneous environment plays a crucial role in IIS longevity, and the insertion angle needs to be considered in future IIS designs and clinical trials.
本研究旨在探讨胰岛素输注套件（IIS）的炎症组织反应（ITR）对胰岛素推注在佩戴时间内的扩散的影响，以及导管插入角度对 ITR、推注形状和泵管压力的影响。
每隔一天将角度或直型 IIS 插入 11 头猪的皮下组织中 14 天，并持续输注胰岛素。在安乐死之前，将 70µL 的胰岛素/射线对比剂推注液注入，同时记录压力曲线（峰值管压，p；压力曲线下面积，AUC），然后切除组织-导管标本。通过微 CT 评估推注液的表面积（SA）和体积（V）。对组织进行染色，以分析围绕导管的总炎症面积（TAI）和炎症层厚度（ILT）。
通过角度 IIS 输送的推注液的平均 SA 大于通过直型导管输送的推注液（314.0±84.2mm 比 229.0±99.7mm，p<0.001），且体积更大（198.7±66.9mm 比 145.0±65.9mm，p=0.001）。这两个值在佩戴时间内都显著减少，与角度无关。TAI（角度，9.1±4.0mm 比直，14.3±8.6mm，p<0.001）和 ILT（角度，0.7±0.4mm 比直，1.2±0.7mm，p<0.001）差异有统计学意义。使用角度 IIS 时，p（p=0.005）和 AUC（p=0.014）更低。随着 ILT 的增加，p 增加，而 SA 和 V 减少。
ITR 的进展直接影响推注形状和管压。虽然直插在临床上更受欢迎，但我们的数据表明，角度 IIS 引起的 ITR 程度较低，并且输送的推注液具有较低的管压和更大的 SA 和 V。皮下环境对 IIS 寿命起着至关重要的作用，因此在未来的 IIS 设计和临床试验中需要考虑插入角度。
