持续皮下注射胰岛素治疗胰岛素过敏临床应用分析.docVIP

持续皮下注射胰岛素治疗胰岛素过敏临床应用分析 　　摘要：目的 讨论持续皮下注射胰岛素（CSII）在胰岛素脱敏治疗临床应用价值。方法 对6例胰岛素过敏者采用续皮下注射胰岛素脱敏治疗，以0.05U/h稀释胰岛素溶液为起始基础率，逐步增加输注速度和浓度，在此基础上调整治疗方案为餐前皮下注射胰岛素联合口服降糖药物治疗（OAD）。结果 6例均脱敏成功，改为皮下注射后未再出现过敏反应。随访2个月，患者空腹血糖（FPG）、餐后2 h血糖（2hPG）和糖化血红蛋白（HbA1c）均下降（P0.01）。结论 持续皮下注射胰岛素和生理性分泌胰岛素相似，可用于胰岛素脱敏治疗。 　　关键词：糖尿病；持续皮下注射胰岛素；脱敏治疗 　　Application and Nursing of Insulin Pump in Desensitization Therapy for Intradermal Insulin Allergy 　　LI Chun-e 　　（Department of Endocrinology，The Peoples Hospital of Dali， Dali 671000，Yunnan，China） 　　Abstract：Objective To evaluate the application value and nursing methods of insulin pump in desensitization therapy for intradermal insulin allergy. Methods Six patients allergic to insulin received desensitization therapy by continuous subcutaneous insulin infusion. The diluted insulin was pumped in initial basal rate of 0.05U/h， and the infusion speed and insulin concentration were increased gradually to the clinically required insulin dosage. After that the continuous subcutaneous insulin infusion was replaced by regimen of insulin subcutaneous injection plus oral ant-diabetes drugs（OAD）. Results All of the 6 cases were successfully desensitized. They did not have the allergic symptoms again after changing to regimen of insulin subcutaneous injection plus OAD. During the follow-up for 2 months， their levels of HbA1c， FPG and 2hPH were all significantly decreased （P0.01）.Conclusion Insulin pump therapy can imitate the secretion of physiological insulin. It can be used for insulin desensitization. 　　Key words：Diabetics mellitus； Continuous subcutaneous insulin infusion； Desensitization treatment 　　胰岛素过敏反应在临床中时有发生，对患者的治疗影响较大，脱敏治疗是针对胰岛素过敏的主要治疗方法，笔者回顾性分析了近几年来本院6例胰岛素过敏患者采用持续皮下注射胰岛素（CSII）脱敏治疗，为临床探讨胰岛素过敏和持续皮下注射胰岛素的关系提供依据。 　　1 资料与方法 　　1.1一般资料 所有选取对象为2010年7月～2015年6月于我院内分泌科住院且胰岛素过敏患者6例，诊断采用1999年WHO糖尿病诊断标准[1]。6例患者男4例，女2例，年龄36～68岁，平均56岁，病程6～22年，排除感染、创伤、糖尿病酮症酸中毒等。6例患者中5例为皮下注射胰岛素7d～5个月后注射部位出现硬块及瘙痒，注射部位出现红晕、丘疹，1例为停用胰岛素6个月及1年后再次输注胰岛素出现局部皮肤瘙痒和风疹块。 　　1.2方法 　　1.2.1胰岛素皮试