胰岛素泵的应用PPT课件

1、胰岛素泵的临床应用一、胰岛素泵的应用基础与现状糖尿病检测技术的进展史insulin injectionsurine test stripsglucose sensorartificialpancreas1999197819221900s1977urine tasting1776bg metersinsulin pump therapy胰岛素泵的应用病例数（不完全统计数）dcctdcct: diabetes care 1995; 18:361-376正常胰岛素分泌规律胰岛素泵模拟胰岛素分泌basal ratepancreas deliverymealbolusespharmacokinetic

2、advantages:csii vs mdin uses only regular insulinnmore predictable absorption than with modified insulins (variation 3% vs 52%*)n uses one injection site for 2 to 3 daysnreduces variations in absorption due to site rotationn eliminates most of the subcutaneous insulin depotn programmable insulin del

3、ivery allows closest match with physiologic needs* lauritzen: diabetologia 1983; 24:326-9胰岛素泵的优点n降低降低hba1chba1cn减少低血糖减少低血糖n提高生活质量提高生活质量n降低治疗费用降低治疗费用胰岛素泵降低hba1cinvestigatornhba1c (%)observation time (yrs)bode (96)557.73.1dcct research group (95)1246.84.5wredling (93)407.64.0-5.6降低hba1c 益处：n 降低微血管病变降低

4、微血管病变n 降低大血管病变降低大血管病变（应用胰岛素尚有争论）（应用胰岛素尚有争论）n 促进伤口愈合促进伤口愈合n 减少感染减少感染n 提高心梗后生存率提高心梗后生存率n 降低自由基对组织的损伤降低自由基对组织的损伤relative riskhba1cskyler: endo met cl n am 1996hba1c 和并发症的相对危险性hba1c 和慢性并发症控制控制餐后血糖水平与冠心病危险性的关系致死性冠心病危险性和血糖浓度的关系致死性冠心病危险性和血糖浓度的关系. p0.001冠心病总发病率和血糖浓度的关系冠心病总发病率和血糖浓度的关系. p0.01n=8006例男性例男性冠心病危险

5、性（1/1000）1.40-114mg/dl2.115-133mg/dl3.134-156mg/dl4.157-189mg/dl5.190-532mg/dl12345 hba1c每增加每增加1%，将增加以下并发症发生危险，将增加以下并发症发生危险胰岛素泵 降低了低血糖的发生率低血糖减少后的益处：n 减少了低血糖脑病减少了低血糖脑病n 减少了低血糖的死亡减少了低血糖的死亡n 提高了患者对低血糖的感知提高了患者对低血糖的感知lifetime benefits of effectiveintensive therapy (dcct)n gain of 15.3 years of complicati

6、on free living compared to conventional therapyn gain of 5.1 years of life compared to conventional therapydcct study group, jama 1996;276:1409-1415.降低医疗开支fhba1c 7% 8% 9% 10%findirect $1,000 $21,400 $44,900 $61,700fdirect $108,400 $109,300 $122,900 $145,600directcostsdirectcostsdirectcostsdirectcost

7、sassumption: patients follow typical scenario. dollars are expected net present valuesource: quattro csii economic analysis model 1999improved quality of lifepump patients demonstrate:nlower anxiety and depression scoresngreater family cohesionnimproved interpersonal sensitivitynsignificantly less d

8、istress from hypoglycemiancoping with diabetes less difficult (adolescents)二、胰岛素泵的应用方法胰岛素剂量的分配50%basalpre-pump dosepump starting dose(70-75% of pre-pump dose)50%bolus基础率的调整n 测三餐前后、入睡时及测三餐前后、入睡时及12am, and 2-4am血糖血糖n 跳餐来测空腹血糖跳餐来测空腹血糖n 按按2-4am 及早餐前的血糖来调整晚间基础率及早餐前的血糖来调整晚间基础率n 调整量不大于调整量不大于0.1 u/hr 调整餐前量n

9、 以碳水化合摄入量来计算确定餐前胰岛素量以碳水化合摄入量来计算确定餐前胰岛素量n 按对胰岛素敏感性的个体差异来确定用量按对胰岛素敏感性的个体差异来确定用量n 再根据餐后血糖及下一餐的餐前血糖来调整用量再根据餐后血糖及下一餐的餐前血糖来调整用量胰岛素泵应用指征n hba1c控制差控制差n 频繁低血糖频繁低血糖n 黎明现象黎明现象n 运动者运动者n 儿科患者儿科患者n 怀孕怀孕n 胃轻瘫胃轻瘫n 忙乱的生活方式忙乱的生活方式n 转移性工作者转移性工作者n 2型糖尿病型糖尿病n 酮症酸中毒酮症酸中毒n 严重慢性病并发症者严重慢性病并发症者n 围手术期患者围手术期患者n 代谢不稳定者代谢不稳定者sum

10、maryn pump therapy is becoming widely recognized as the best way to treat insulin requiring diabetesn continuous glucose monitoring makes pumps an even more powerful tooln both pump therapy and continuous glucose monitoring are easy to implement in a medical practice小 结 临时胰岛素泵的应用 (i)v适用适用dka的病人的病人:给

11、予生理剂量胰岛素给予生理剂量胰岛素,快速改快速改变糖代谢紊乱变糖代谢紊乱,纠正酸碱失衡纠正酸碱失衡.v适用高渗昏迷的严重糖代谢紊乱的病人适用高渗昏迷的严重糖代谢紊乱的病人:全面治全面治疗的同时理想地纠正糖代谢紊乱疗的同时理想地纠正糖代谢紊乱,稳妥地恢复血稳妥地恢复血浆渗透压及心、脑、肾等脏器的功能浆渗透压及心、脑、肾等脏器的功能.v适用多脏器功能衰竭伴高血糖的病人适用多脏器功能衰竭伴高血糖的病人:可以减少可以减少输液量输液量,避免进一步加重器官功能衰竭并纠正高避免进一步加重器官功能衰竭并纠正高血糖血糖.v适用于胰岛素抵抗的病人适用于胰岛素抵抗的病人:可以摸索胰岛素的治可以摸索胰岛素的治疗剂量疗剂量.v减少低血糖的发生减少低血糖的发生.v防止高渗透压防止高渗透压-低渗透压波动所致的脑水肿低渗透压波动所致的脑水肿综合效益