- 期刊
Continuous Ambulatory Peritoneal Dialysis in Diabetic Patients with End-Stage Renal Disease: Experience with Intraperitoneal Insulin Therapy
糖尿病尿毒病病人之連續性可攜帶式腹膜透析－腹膜內注射胰島素治療之經驗
摘要
糖尿病引起的尿毒症有愈來愈多的傾向。由於連續性可攜帶式腹膜透析（CAPD）能提供糖尿病尿毒症病人許多好處，目前已有不少病人接受此種治療；另外胰島素也可直接注入透析液內進入腹膜腔而吸收，可免除長期皮下注射的痛苦。本研究針對9名糖尿病尿毒症病人，以CAPD伴腹膜內注射胰島素方式治療，而觀察其效果。此9名病人包括5男4女，平均年齡57±12歲。 本研究結果，血清三酸甘油脂及膽固醇在所有病人均上升而其他血清生化檢查結果大多有轉好現象，高血壓可獲得明顯改善。胰島素需要量由每天50到180單位（平均129±34單位）不等。此劑量是原來皮下注射量的4.2±1.6倍，而加人透析液內的胰島素有55-65%被吸附在袋子上。以腹膜內方式注射胰島素治療後，病人的平均血糖值較低且變動較小，故糖尿病本身可得到較好的控制。腹膜炎的發生率是平均每個病人每16.9個月發生一次，此發生率較非糖尿病尿毒症病人稍低，而平均住院日數是每年14.9±11.2日，此日數則比非糖尿病尿毒症病人為高。病人的1年存活率是89 %，而2年存活率是74%。以上結果顯示CAPD是糖尿病尿毒症病人一種很好的治療方式，而以腹膜內注射胰島素方式治療能對糖尿病提供很好的治療效果。
關鍵字
無資料並列摘要
Continuous ambulatory peritoneal dialysis (CAPD) is a valuable alternative to hemodialysis in treating uremic diabetics, and insulin can be injected directly into dialysate and absorbed intraperitoneally (IP). We evaluated the effect of IP supply of insulin in 9 uremic diabetics undergoing CAPD therapy. The 9 patients included 5 males and 4 females, with a mean age of 57±12 years old. The study showed that serum biochemistry was stationary during the treatment period except for the variable elevations of serum triglyceride and cholesterol. Hypertension was easily controlled in most patients. The insulin requirements ranged from 50 to 180 (129±34) units/day, which was 4.2±1.6 times higher than the the subcutaneous doses before dialysis. Insulin added to the dialysate showed a high percentage of adsorption (55% to 65%) onto the plastic bag. The blood glucose levels varied less after an IP supply of insulin. The overall incidence of peritonitis was 8 episodes in 135 patient months (one episode every 16.9 patient months), and the average duration of hospitalization was 14.9±11.2 days/year. The cumulative survival rates were 89% in the first year and 74% in the second year. Our experience indicates that CAPD is an ideal treatment modality for uremic diabetics, and IP supply of insulin results in a good control of diabetes.
延伸閱讀
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