摘要
目的:比较口服降糖药和皮下注射胰岛素两种降糖方案对老年糖尿病合并社区获得性肺炎非重症患者临床疗效的影响。方法:选取2017年1月—2019年12月某医院收治的血糖控制不佳的老年糖尿病合并社区获得性肺炎非重症患者共293例,将其随机分为口服降糖药组(146例)和胰岛素治疗组(147例)。两组均给予规范的抗感染治疗,口服降糖药组给予口服药物控制血糖,胰岛素治疗组给予胰岛素皮下注射控制血糖。比较两组退热时间、细菌清除率、重症转化率、肺部CT吸收程度、炎症指标、平均血糖、血糖不稳定指数、低血糖发生率。结果:胰岛素治疗组在退热时间、细菌清除率、重症转化率、肺部CT吸收程度、平均血糖及血糖波动方面均优于口服降糖药组,但炎症指标的改善和低血糖发生率差异无统计学意义(P>0.05)。结论:对于口服降糖药血糖,控制不佳的老年糖尿病合并非重症社区获得性肺炎患者,在规范抗感染治疗的同时改用胰岛素控制血糖,可以更好地控制肺部感染和血糖而不增加低血糖发生的风险,可作为一种优选的临床策略。
OBJECTIVE To explore the clinical efficacy of adjusting oral hypoglycemic agents and switching to subcutaneous in⁃sulin injection regimen in elderly patients with non-severe community-acquired pneumonia METHODS A total of 293 eligible pa⁃tients admitted from January 2017 to December 2019 were randomly divided into oral hypoglycemic group(146 cases)and insulin treatment group(147 cases).All patients were given anti-infection treatment,one group adjusted oral hypoglycemic drugs to keep blood sugar under control,while another by subcutaneous injection of insulin.Antipyretic time,bacterial clearance rate,conversion,severe lung CT absorption rate,inflammation index,average blood sugar,blood glucose instability index,incidence of hypoglycemia were compared between two groups.RESULTS Compared with oral hypoglycemic drugs group,patients who accepted insulin injec⁃tion had shorter antipyretic time,higher bacterial clearance,lower severe rate,better CT absorption,better and smooth blood glucose control.The incidence of hypoglycemia and inflammation index improvement were no statistical difference between two groups.CON⁃CLUSION For elderly diabetic patients with non-severe community-acquired pneumonia accepted oral hypoglycemic drugs but in poor glycemic switch to subcutaneous injections of insulin to control blood glucose got better control of infection and glycemic,while didn’t increase the risk of hypoglycemia occurs.It could be a kind of optimization of clinical strategies.
作者
张珏
刘芹芹
何文辉
何方
ZHANG Jue;LIU Qin-qin;HE Wen-hui;HE Fang(The Fourth Hospital Affiliated to Tongji University,Shanghai,200081,China)
出处
《中国初级卫生保健》
2021年第8期88-91,共4页
Chinese Primary Health Care
关键词
社区获得性肺炎
老年患者
糖尿病
胰岛素
community-acquired pneumonia
elderly patients
diabetes mellitus
insulin
