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目的 总结解放军总医院不同科室住院糖尿病患者降糖治疗方式的应用情况及其变化.方法 以2000年1月至2014年5月于解放军总医院非内分泌科住院治疗的糖尿病患者为研究对象,采用分层随机抽样的方法,共抽取内科科室(内分泌科除外)和外科科室住院糖尿病患者10041例,利用病案检索系统,对所有患者的住院资料进行回顾性分析,并应用χ2检验比较各组率的差异.结果 此次调查共纳入住院患者10041例,其中男性5502例(54.8%),女性4539例(45.2%),男性多于女性.非内分泌科住院糖尿病患者以中老年为主,平均就诊年龄(62±14)岁.住院患者中,49.8%仅用口服降糖药,37.2%仅用胰岛素,13.0%联用口服药和胰岛素治疗.内科患者中54.7%使用口服药治疗,其中使用单一药物者占36.5%,两种药物联用者占16.5%,三种及以上药物联合者仅占1.7%.外科住院患者中,单用口服药者占43.8%,而应用胰岛素治疗的比例高于内科[56.2%(2526/4497)比45.3%(2510/5544),χ2=117.928,P<0.01].近15年间,降糖治疗方式有所改变,单用口服药治疗的比例下降[71.1%(589/828)比46.0%(2315/5036),χ2=271.087,P<0.01],单用胰岛素治疗的比例升高[22.1%(183/828)比38.9%(1963/5036),χ2=120.369,P<0.01],口服药联合胰岛素的比例增加[6.8% (56/828)比15.1%(758/5036),χ2=96.989,P<0.01].结论 非内分泌科住院糖尿病患者多数使用口服降糖药,不同科室降糖治疗方式有所不同,内科患者以口服药治疗为主,而外科患者降糖药物以胰岛素为主.近年来,单用胰岛素及口服药联合胰岛素治疗的比例有所增加.

Objective To summarize the current status and change of anti-diabetic medication regimen of diabetic patients hospitalized to different departments in Chinese PLA General Hospital. Methods The clinical data of patients with diabetes admitted to Chinese PLA General Hospital from January 2001 to May 2014 were collected(the patients hospitalized in the Department of Endocrinology were excluded). Total of 10 041 patients were selected by stratified random sampling. The type of anti-diabetic medication regimen in different departments and the variation on antihyperglycemic treatment strategies with time were retrospectively analyzed.Data were compared with chi-square among the groups.Results A total of 10 041 patients with diabetes mellitus were selected,of whom 5 502(54.8%)were male and 4 539 (45.2%)were female.The overall mean age was(62±14)years.Of all the patients,49.8% were treated with oral antidiabetic drugs (OADs) alone, 37.2% used insulin only and 13.0% of the patients received OADs plus insulin. About 54.7% of patients in internal medicine department were treated with OADs, among which, monotherapy accounted for 36.5%, two OADs combination took up 16.5%, three or more OADs combination took up 1.7%. While those in surgical department preferred insulin for treatment when compared their counterparts in internal medicine departments[56.2%(2 526/4 497)vs 45.3%(2 510/5 544), χ2=117.928, P<0.001]. During the past 15 years, the number of patients treated with OADs alone reduced [71.1%(589/828) vs 46.0%(2 315/5 036), χ2=271.087, P<0.01], while the number of those using insulin alone or OADs plus insulin increased[22.1%(183/828)vs 38.9%(1 963/5 036),6.8%(56/828)vs 15.1%(758/5 036),χ2=120.369,96.989,both P<0.01].Conclusions The anti-diabetic medication regimen is different in different departments.Insulin therapy was more common in surgical department than in internal medicine department. In the past 15 years, the percentage of patients using insulin alone or OADs plus insulin increases with time.