INSULIN INFUSION WITH PARENTERAL-NUTRITION IN EXTREMELY LOW BIRTH-WEIGHT INFANTS WITH HYPERGLYCEMIA
INSULIN INFUSION WITH PARENTERAL-NUTRITION IN EXTREMELY LOW BIRTH-WEIGHT INFANTS WITH HYPERGLYCEMIA
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DOI：
10.1016/s0022-3476(89)80797-8
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发表时间：
1989-02-01
影响因子：
5.1
通讯作者：
REYNOLDS, JW
中科院分区：
文献类型：
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作者：
BINDER, ND;RASCHKO, PK;REYNOLDS, JW
从1983年11月7日到1986年11月6日，所有出生体重≤的婴儿俄勒冈州健康科学大学收治的1000 gm患有持续性高血糖症和糖尿的患者接受分级胰岛素输注治疗，同时将能量摄入增加至至少100 kcal/kg/天（419 kJ/kg/天）。对这些婴儿的记录进行了审查，以确定可能出现高血糖症的婴儿的临床特征，并了解胰岛素给药是否可以实现能量摄入目标。有76名存活的婴儿; 34名接受了胰岛素治疗，42名没有。接受治疗的婴儿较小（767 . ±. 161对872 +-。98 gm; p = 0.0004），更不成熟（26.8 . 1.4对比27.7 .+-。2.0周; p = 0.0115），并且需要更长时间的机械通气（28 . ±. 19比17 +-。15天; p = 0.0196）。静脉注射葡萄糖或第3、7、10、14、28或56天的总非蛋白质能量摄入量在第3、7、10或14天组间无显著差异。 在15 ± 10 ℃时，接受治疗的婴儿达到100千卡/千克/天（419千焦/千克/天）的摄入量。8比17 +-。11天，并在12 . ±.时恢复出生体重。6比13 +-。6天（NS）。在第7、14、28或56天，与出生体重相比的百分比变化无差异。接受治疗的婴儿的葡萄糖浓度为195 ± 100。60 mg/dl（10.8 ±. 3.3 mmol/L），而接受7.9 . ±-. 3.0 mg/kg/min（43 . ±. 17 μ mol/kg/min）的葡萄糖。胰岛素治疗1 ~ 58天。初始剂量为40至100 mU/gm葡萄糖输注（57至142 nmol/mol），然后逐渐降低。低于0.5%的血糖值为25 - 40 mg/dl（1.4 - 2.2 mmol/L）。我们的结论是，胰岛素输注可改善极低出生体重儿的葡萄糖耐量，并使高血糖婴儿获得与未发生高血糖的婴儿相似的充足能量摄入。
From Nov. 7, 1983, to Nov. 6, 1986, all infants with birth weight .ltoreq. 1000 gm admitted to Oregon Health Sciences University who had persistent hyperglycemia and glycosuria were treated with graded insulin infusion while energy intake was increased to at least 100 kcal/kg/day (419 kilojoules/kg/day). The records of these infants were reviewed to define the clinical characteristics of infants likely to develop hyperglycemia and to see whether insulin administration would allow goals for energy intake to be met. There were 76 surviving infants; 34 received insulin and 42 did not. Treated infants were smaller (767 .+-. 161 vs 872 .+-. 98 gm; p = 0.0004), were more immature (26.8 .+-. 1.4 vs 27.7 .+-. 2.0 weeks; p = 0.0115), and required mechanical ventilation longer (28 .+-. 19 vs 17 .+-. 15 days; p = 0.0196). There were no significant differences between the groups of 3, 7, 10, or 14 days for intravenously administered glucose or for total nonprotein energy intake at 3, 7, 10, 14, 28, or 56 days. Treated infants achieved an intake of 100 kcal/kg/day (419 kilojoules/kg/day) at 15 .+-. 8 vs 17 .+-. 11 days and regained birth weight at 12 .+-. 6 vs 13 .+-. 6 days (NS). There was no difference in percent change from birth weight at 7, 14, 28 or 56 days. Treated infants had a glucose concentration of 195 .+-. 60 mg/dl (10.8 .+-. 3.3 mmol/L) while receiving 7.9 .+-. 3.0 mg/kg/min (43 .+-. 17 .mu.mol/kg/min) of glucose at the start of insulin infusion on days 1 to 14. Insulin was given for 1 to 58 days. The initial dose was 40 to 100 mU/gm of dextrose infused (57 to 142 nmol/mol) and then gradually decreased. Less than 0.5% of blood glucose values were 25 to 40 mg/dl (1.4 to 2.2 mmol/L). We conclude that insulin infusion improves glucose tolerance in extremely low birth weight infants and allows hyperglycemic infants to achieve adequate energy intake similar to that of infants who do not become hyperglycemic.