1、胰島素泵的應用PPT課件胰島素泵的臨床應用胰島素泵的臨床應用胰島素泵的應用PPT課件一、胰島素泵的應用基礎胰島素泵的應用基礎與現狀與現狀胰島素泵的應用PPT課件糖尿病檢測技術的進展史Insulin InjectionsUrine Test StripsGlucose SensorArtificialPancreas1999197819221900s1977Urine Tasting1776BG MetersInsulin Pump Therapy胰島素泵的應用PPT課件胰島素泵的應用病例數（不完全統計數）6,6008,70011,40015,00020,00026,50035,00043,00

2、060,00081,000100,000150,000010,00020,00030,00040,00050,00060,00070,00080,00090,000100,000110,000120,000130,000140,000150,000909192939495969798990002胰島素泵的應用PPT課件DCCTDCCT: Diabetes Care 1995; 18:361-376Unknown2%Pump42%MDI56%胰島素泵的應用PPT課件正常胰島素分泌規律胰島素泵的應用PPT課件胰島素泵模擬胰島素分泌Basal RatePancreas DeliveryMealBol

3、uses胰島素泵的應用PPT課件Pharmacokinetic Advantages:CSII vs MDI Uses only Regular insulin More predictable absorption than with modified insulins (variation 3% vs 52%*) Uses one injection site for 2 to 3 days Reduces variations in absorption due to site rotation Eliminates most of the subcutaneous insulin de

4、pot Programmable insulin delivery allows closest match with physiologic needs* Lauritzen: Diabetologia 1983; 24:326-9胰島素泵的應用PPT課件胰島素泵的優點 降低降低HbA1cHbA1c 減少低血糖減少低血糖 提高生活質量提高生活質量 降低治療費用降低治療費用胰島素泵的應用PPT課件胰島素泵降低胰島素泵降低HbA1cInvestigatorNHbA1c (%)Observation Time (yrs)Bode (96)557.73.1DCCT Research Group (9

5、5)1246.84.5Wredling (93)407.64.0-5.6胰島素泵的應用PPT課件降低HbA1c 益處： 降低微血管病變 降低大血管病變（應用胰島素尚有爭論） 促進傷口愈合 減少感染 提高心梗后生存率 降低自由基對組織的損傷胰島素泵的應用PPT課件135791113156789101112RetinopNephNeuropMicroalbRELATIVE RISKHbA1cSkyler: Endo Met Cl N Am 1996HbA1c 和并發癥的相對危險性胰島素泵的應用PPT課件HbA1c 和慢性并發癥控制胰島素泵的應用PPT課件餐后血糖水平與冠心病危險性的關系致死性冠心病

6、危險性和血糖濃度的關系. p0.001冠心病總發病率和血糖濃度的關系. p0.01n=8006例男性0 01010202030304040505060607070致死性冠心病致死性冠心病冠心病總發病率冠心病總發病率1 12 23 34 45 5冠心病危險性（1/1000）1.40-114mg/dl2.115-133mg/dl3.134-156mg/dl4.157-189mg/dl5.190-532mg/dl12345胰島素泵的應用PPT課件21%21%14%14%47%47%39%39%19%19%外周血管心肌梗死糖尿病相關死亡微血管白內障摘除 HbA1C每增加每增加1%，將增加以下并發癥發生

7、危險，將增加以下并發癥發生危險胰島素泵的應用PPT課件胰島素泵 降低了低血糖的發生率13813822222626393936360 05050100100150150Pre CSIIPre CSII1 yr1 yr2 yr2 yr3 yr3 yr4 yr4 yr- With CSII-胰島素泵的應用PPT課件低血糖減少后的益處： 減少了低血糖腦病減少了低血糖腦病 減少了低血糖的死亡減少了低血糖的死亡 提高了患者對低血糖的感知提高了患者對低血糖的感知胰島素泵的應用PPT課件Lifetime Benefits of EffectiveIntensive Therapy (DCCT) Gain of

8、 15.3 years of complication free living compared to conventional therapy Gain of 5.1 years of life compared to conventional therapyDCCT Study Group, JAMA 1996;276:1409-1415.胰島素泵的應用PPT課件降低醫療開支$108,400$130,700$167,800$207,300PumpMDIConventional(DCCT)Conventional(GeneralPopulation)FHbA1c 7% 8% 9% 10%FI

9、ndirect $1,000 $21,400 $44,900 $61,700FDirect $108,400 $109,300 $122,900 $145,600DirectCostsDirectCostsDirectCostsDirectCostsAssumption: Patients follow typical scenario. Dollars are Expected Net Present ValueSource: Quattro CSII Economic Analysis Model 1999胰島素泵的應用PPT課件Improved Quality of LifePump p

10、atients demonstrate: Lower anxiety and depression scores Greater family cohesion Improved interpersonal sensitivity Significantly less distress from hypoglycemia Coping with diabetes less difficult (adolescents)胰島素泵的應用PPT課件二、胰島素泵的應用方法胰島素泵的應用方法胰島素泵的應用PPT課件胰島素劑量的分配50%BasalPre-Pump DosePump Starting Do

11、se(70-75% of Pre-Pump Dose)50%Bolus胰島素泵的應用PPT課件基礎率的調整 測三餐前后、入睡時及12am, and 2-4am血糖 跳餐來測空腹血糖 按2-4am 及早餐前的血糖來調整晚間基礎率 調整量不大于0.1 u/hr 胰島素泵的應用PPT課件調整餐前量 以碳水化合攝入量來計算確定餐前胰島素量 按對胰島素敏感性的個體差異來確定用量 再根據餐后血糖及下一餐的餐前血糖來調整用量胰島素泵的應用PPT課件胰島素泵應用指征 HbA1c控制差 頻繁低血糖 黎明現象 運動者 兒科患者 懷孕 胃輕癱 忙亂的生活方式 轉移性工作者 2型糖尿病 酮癥酸中毒 嚴重慢性病并發癥者

12、 圍手術期患者 代謝不穩定者胰島素泵的應用PPT課件Summary Pump Therapy is becoming widely recognized as the best way to treat insulin requiring diabetes Continuous Glucose Monitoring makes pumps an even more powerful tool Both Pump Therapy and Continuous Glucose Monitoring are easy to implement in a medical practice胰島素泵的應用

13、PPT課件小小 結結 臨時胰島素泵的應用臨時胰島素泵的應用 (I)v適用適用DKA的病人的病人:給予生理劑量胰島素給予生理劑量胰島素,快速改快速改變糖代謝紊亂變糖代謝紊亂,糾正酸堿失衡糾正酸堿失衡.v適用高滲昏迷的嚴重糖代謝紊亂的病人適用高滲昏迷的嚴重糖代謝紊亂的病人:全面全面治療的同時理想地糾正糖代謝紊亂治療的同時理想地糾正糖代謝紊亂,穩妥地恢復穩妥地恢復血漿滲透壓及心、腦、腎等臟器的功能血漿滲透壓及心、腦、腎等臟器的功能.胰島素泵的應用PPT課件v適用多臟器功能衰竭伴高血糖的病人適用多臟器功能衰竭伴高血糖的病人:可以減可以減少輸液量少輸液量,避免進一步加重器官功能衰竭并糾正避免進一步加重器官功能衰竭并糾正高血糖高血糖.v適用于胰島素抵抗的病人適用于胰島素抵抗的病人:可以摸索胰島素的可以摸索胰島素的治療劑量治療劑量.v減少