胰岛素泵的临床应用讲解课件.ppt

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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InsulinInjectionsUrineTestStripsGlucoseSensorArtificialPancreas1999197819221900s1977UrineTasting1776BGMetersInsulinPumpTherapy胰岛素泵的应用病例数（不完全统计数）DCCTDCCT:DiabetesCare1995;18:361-376正常胰岛素分泌规律胰岛素泵模拟胰岛素分泌BasalRatePancreasDeliveryMealBolusesPharmacokinet

2、icAdvantages:CSIIvsMDIUsesonlyRegularinsulinMorepredictableabsorptionthanwithmodifiedinsulins(variation3%vs52%*)Usesoneinjectionsitefor2to3daysReducesvariationsinabsorptionduetositerotationEliminatesmostofthesubcutaneousinsulindepotProgrammableinsulindeliveryallowsclosestmatchwithphy

3、siologicneeds*Lauritzen:Diabetologia1983;24:326-9胰岛素泵的优点降低HbA1c减少低血糖提高生活质量降低治疗费用胰岛素泵降低HbA1cInvestigatorNHbA1c(%)ObservationTime(yrs)Bode(’96)557.73.1DCCTResearchGroup(’95)1246.84.5Wredling(’93)407.64.0-5.6降低HbA1c益处：降低微血管病变降低大血管病变（应用胰岛素尚有争论）促进伤口愈合减少感染提高心梗后生存率降低自由基对组织的损伤RELATIVERISKHbA1

4、cSkyler:EndoMetClNAm1996HbA1c和并发症的相对危险性HbA1c和慢性并发症控制足溃疡心绞痛心血管冠脉搭桥卒中失眠截肢透析肾移植微量白蛋白尿视网膜病（轻）神经病变（轻）白蛋白尿增生性视网膜病牙周病阳蒌胃轻瘫抑郁危险性控制良好控制差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.p＜0.001冠心病总发病率和血糖浓度的关系.p＜0.01n=8006例男性冠心病危险性（1/1000）1.40-114mg/dl2.115-133mg/dl3.134-156mg/dl4.157-189mg/dl5.190-532mg/dl123

5、45HbA1C每增加1%，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：减少了低血糖脑病减少了低血糖的死亡提高了患者对低血糖的感知LifetimeBenefitsofEffectiveIntensiveTherapy(DCCT)Gainof15.3yearsofcomplicationfreelivingcomparedtoconventionaltherapyGainof5.1yearsoflifecomparedtoconventionaltherapyDCCTStudyGroup,JAMA1996;276:1409-1415.降

6、低医疗开支HbA1c7%8%9%10%Indirect$1,000$21,400$44,900$61,700Direct$108,400$109,300$122,900$145,600DirectCostsDirectCostsDirectCostsDirectCostsAssumption:Patientsfollowtypicalscenario.DollarsareExpectedNetPresentValueSource:QuattroCSIIEconomicAnalysisModel1999ImprovedQualityofLifePumppat

7、ientsdemonstrate:LoweranxietyanddepressionscoresGreaterfamilycohesionImprovedinterpersonalsensitivitySignificantlylessdistressfromhypoglycemiaCopingwithdiabeteslessdifficult(adolescents)二、胰岛素泵的应用方法胰岛素剂量的分配50%BasalPre-PumpDosePumpStartingDose(70-75%ofPre-PumpDose)50%Bolus基础率的调整测三餐前后、入睡

8、时及12a