Wiggam M I, O'Kane M J, Harper R, Atkinson A B, Hadden D R, Trimble E R, Bell P M
Sir George E Clark Metabolic Unit, Royal Victoria Hospital, Belfast, Northern Ireland, U.K.
Diabetes Care. 1997 Sep;20(9):1347-52. doi: 10.2337/diacare.20.9.1347.
To compare the efficacy of an extended insulin regimen using correction of hyperketonemia as endpoint with a more conventional regimen in the treatment of diabetic ketoacidosis.
A total of 22 patients admitted to a Belfast teaching hospital with clinical and biochemical features of diabetic ketoacidosis (pH < 7.25 and/or bicarbonate < 16 mmol/l) were randomized to either conventional or extended insulin regimens. In the conventional regimen, insulin was administered at 5 U/h until near-normoglycemia (blood glucose < or = 10 mmol/l) and then administered at a reduced rate until clinical recovery. In the extended regimen, administration of insulin at 5 U/h was continued beyond attainment of normoglycemia, until resolution of hyperketonemia (3-hydroxybutyrate < 0.5 mmol/l). Main outcome measures were 3-hydroxybutyrate and bicarbonate levels during the 24 h after attainment of near-normoglycemia.
After near-normoglycemia, correction of hyperketonemia was achieved earlier with the extended treatment (5.9 +/- 0.8 vs. 21.8 +/- 3.4 h, P = 0.0004 [mean +/- SD]). The area under the curve of 3-hydroxybutyrate against time for 24 h after near-normoglycemia was reduced with the extended treatment (24.9 +/- 3.8 vs. 55.9 +/- 6.7 mmol.l-1.h-1, P = 0.001). These differences remained statistically significant after adjustment for higher baseline levels of 3-hydroxybutyrate at near-normoglycemia in the extended treatment group. Bicarbonate levels at 6 and 12 h after near-normoglycemia were not significantly different between groups.
The extended insulin regimen, which was easy to implement at ward level, produced a more rapid resolution of ketosis than the conventional regimen.
比较以纠正高酮血症为终点的延长胰岛素治疗方案与更传统方案治疗糖尿病酮症酸中毒的疗效。
共有22例因糖尿病酮症酸中毒临床及生化特征（pH < 7.25和/或碳酸氢盐 < 16 mmol/l）入住贝尔法斯特教学医院的患者被随机分为传统胰岛素治疗方案组或延长胰岛素治疗方案组。在传统方案中，胰岛素以5 U/h的速度给药，直至血糖接近正常（血糖≤10 mmol/l），然后以较低速度给药直至临床康复。在延长方案中，血糖达到正常后继续以5 U/h的速度给予胰岛素，直至高酮血症消退（3-羟基丁酸<0.5 mmol/l）。主要观察指标为血糖接近正常后24小时内的3-羟基丁酸和碳酸氢盐水平。
血糖接近正常后，延长治疗组高酮血症的纠正时间更早（5.9±0.8 vs. 21.8±3.4小时，P = 0.0004 [平均值±标准差]）。延长治疗使血糖接近正常后24小时内3-羟基丁酸随时间变化的曲线下面积减小（24.9±3.8 vs. 55.9±6.7 mmol·l-1·h-1，P = 0.001）。在对延长治疗组血糖接近正常时较高的3-羟基丁酸基线水平进行调整后，这些差异仍具有统计学意义。血糖接近正常后6小时和12小时时，两组间碳酸氢盐水平无显著差异。
延长胰岛素治疗方案在病房层面易于实施，与传统方案相比，能更迅速地消除酮症。
