1型糖尿病儿童院外长期应用胰岛素泵治疗的临床观察

Clinical Observation of Long-Term Therapy of Continuous Subcutaneous Insulin Infusion in Type 1 Diabetes Mellitus Children

摘要: 目的：探讨1型糖尿病(Type 1 Diabetes Mellitus, T1DM)儿童应用胰岛素泵(Continuous Subcutaneous Insulin Infusion, CSII)治疗的临床效果，分析院外CSII治疗过程中存在的问题，为CSII长期治疗的随访管理提供指导依据。方法：2019年1月至2019年6月对长期在青岛妇女儿童医院内分泌科门诊随访的使用美敦力722 CSII治疗6个月以上、年龄18岁以下且长期居住于青岛地区的40例T1DM儿童进行问卷调查，了解患儿糖化血红蛋白(Glycosylated Hemoglobin A1c, HbA1c)水平及治疗过程中出现的问题。结果：T1DM儿童经CSII治疗后HbA1c为(7.12 ± 1.11)%，较CSII治疗前HbA1c (9.58 ± 2.08)%显著下降，差异有统计学意义(t = 7.315, P < 0.05)。在治疗过程中，患儿出现皮肤并发症，有低血糖及酮症酸中毒发生。结论：T1DM儿童院外要达到最佳血糖控制效果，取得较为满意的临床疗效，不能单纯依靠CSII，科学、规范化的管理是极其重要的。

Abstract: Objective: To investigate the clinical effect in children with Type 1 Diabetes Mellitus (T1DM) who used of Insulin pump (Continuous Subcutaneous Insulin Infusion, CSII) therapy, analyze the problems existing in the treatment of CSII outside the hospital and provide theoretical guidance for application of CSII in long-term therapy and follow-up management. Methods: From January 2019 to June 2019, 40 T1DM children with Medtronic 722 CSII for more than 6 months in the outpatient department of endocrinology of Qingdao women and children’s hospital, who were under 18 years old and lived in Qingdao for a long time, were followed up with questionnaires to the level of Glycosylated Hemoglobin A1c (HbA1c) and the problems in the therapy process. Results: The HbA1c was (7.12 ± 1.11)% in children with T1DM after treatment with CSII, which was significantly lower than the HbA1c (9.58 ± 2.08)% before CSII treatment. The difference was statistically significant (t = 7.315, P < 0.05). During the treatment, the child had skin complications, hypoglycemia and ketoacidosis. Conclusions: To achieve the best glycemic control effect and obtain satisfactory clinical efficacy outside the hospital, T1DM children cannot rely solely on CSII, scientific and standardized management is extremely important.