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1、胰島素泵的臨床應(yīng)用一、胰島素泵的應(yīng)用基礎(chǔ) 與現(xiàn)狀糖尿病檢測技術(shù)的進(jìn)展史InsulinInjectionsUrineTestStripsGlucoseSensorArtificial Pancreas1999197819221900s1977UrineTasting1776BGMetersInsulinPumpTherapy胰島素泵的應(yīng)用病例數(shù)（不完全統(tǒng)計數(shù)）DCCTDCCT:DiabetesCare1995;18:361-376正常胰島素分泌規(guī)律胰島素泵模擬胰島素分泌BasalRatePancreasDeliveryMealBolusesPharmacokinet
2、icAdvantages: CSIIvsMDIUsesonlyRegularinsulinMorepredictableabsorptionthanwithmodifiedinsulins(variation3%vs52%*)Usesoneinjectionsitefor2to3daysReducesvariationsinabsorptionduetositerotationEliminatesmostofthesubcutaneousinsulindepotProgrammableinsulindeliveryallowsclosestmatchwithphy
3、siologicneeds*Lauritzen:Diabetologia1983;24:326-9胰島素泵的優(yōu)點降低HbA1c減少低血糖提高生活質(zhì)量降低治療費(fèi)用胰島素泵降低HbA1cInvestigatorNHbA1c(%)ObservationTime(yrs)Bode(’96)557.73.1DCCTResearchGroup(’95)1246.84.5Wredling(’93)407.64.0-5.6降低HbA1c益處：降低微血管病變降低大血管病變（應(yīng)用胰島素尚有爭論）促進(jìn)傷口愈合減少感染提高心梗后生存率降低自由基對組織的損傷RELATIVERISKHbA1
4、cSkyler:EndoMetClNAm1996HbA1c和并發(fā)癥的相對危險性HbA1c和慢性并發(fā)癥控制足潰瘍心絞痛心血管冠脈搭橋卒中失眠截肢透析腎移植微量白蛋白尿視網(wǎng)膜?。ㄝp）神經(jīng)病變（輕）白蛋白尿增生性視網(wǎng)膜病牙周病陽蔞胃輕癱抑郁危險性控制良好控制差餐后血糖水平與冠心病危險性的關(guān)系致死性冠心病危險性和血糖濃度的關(guān)系.p＜0.001冠心病總發(fā)病率和血糖濃度的關(guān)系.p＜0.01n=8006例男性冠心病危險性（1/1000）1.40-114mg/dl2.115-133mg/dl3.134-156mg/dl4.157-189mg/dl5.190-532mg/dl123
5、45HbA1C每增加1%，將增加以下并發(fā)癥發(fā)生危險胰島素泵降低了低血糖的 發(fā)生率低血糖減少后的益處：減少了低血糖腦病減少了低血糖的死亡提高了患者對低血糖的感知LifetimeBenefitsofEffective IntensiveTherapy(DCCT)Gainof15.3yearsofcomplicationfreelivingcomparedtoconventionaltherapyGainof5.1yearsoflifecomparedtoconventionaltherapyDCCTStudyGroup,JAMA1996;276:1409-1415.降
6、低醫(yī)療開支HbA1c7%8%9%10%Indirect$1,000$21,400$44,900$61,700Direct$108,400$109,300$122,900$145,600Direct CostsDirect CostsDirect CostsDirect CostsAssumption:Patientsfollowtypicalscenario.DollarsareExpectedNetPresentValueSource:QuattroCSIIEconomicAnalysisModel1999ImprovedQualityofLifePumppat
7、ientsdemonstrate:LoweranxietyanddepressionscoresGreaterfamilycohesionImprovedinterpersonalsensitivitySignificantlylessdistressfromhypoglycemiaCopingwithdiabeteslessdifficult(adolescents)二、胰島素泵的應(yīng)用方法胰島素劑量的分配50%BasalPre-PumpDosePumpStartingDose(70-75%ofPre-PumpDose)50%Bolus基礎(chǔ)率的調(diào)整測三餐前后、入睡
8、時及12a
