目的：探讨围手术期2型糖尿病（type 2 diabetes mellitus，T2DM）患者胰岛素泵治疗期间低血糖发生情况及其相关危险因素。方法：研究对象选取北京积水潭医院骨折合并T2DM围手术期行胰岛素泵强化治疗患者，共96例。收集病史，检测糖化血红蛋白（glycosylated hemoglobin, HbA_1c）、肝功能、肾功能等指标，观察低血糖发生及术后并发症情况。采用Logistic回归分析探讨低血糖相关危险因素。结果：骨折合并T2DM患者术前胰岛素泵强化治疗至血糖达标时间为（2.8±1.3） d，总体低血糖发生率为15.6%。低血糖组15例，非低血糖组81例，与非低血糖组相比，低血糖组的年龄更大[（71.1±11.1）岁比（56.0±10.6）岁，P=0.000]、病程更长[14.0（8.8~17.8）年比5.0（2.8~12.0）年，P=0.017]、估算的肾小球滤过率（estimated glomerular filtration rate, eGFR）更低[（78.7±27.5）mL/（min·1.73 m²）比（106.8±15.0）mL/（min·1.73 m²），P=0.005]、术后感染发生率更高（25%比3%，P=0.024）。多因素Logistic回归分析显示年龄大（OR=1.172，95%CI：1.027~1.091，P=0.012）、病程长（OR=1.193，95%CI：1.001~1.420，P=0.049）和eGFR低（OR=0.950，95%CI：0.903~0.998，P=0.049）是围手术期T2DM患者胰岛素泵治疗发生低血糖的危险因素。结论：围手术期T2DM患者胰岛素泵治疗可使血糖快速达标；年龄大、糖尿病病程长以及eGFR水平低是低血糖发生的危险因素。

Objective To investigate the occurrence and risk factors of type 2 diabetes mellitus (T2DM) patient treated with continuous subcutaneous insulin infusion (CSII) hypoglycemia during perioperative period. Methods A total of 96 patients with fractures and T2DM who received CSII therapy during perioperative period in Beijing Jishuitan Hospital were selected as research subjects. Clinical data including medical history, glycosylated hemoglobin (HbA_1c), liver and kidney function, occurrence of hypoglycemia and postoperative complications were collected. Logistic regression analysis was used to analyze the risk factors of hypoglycemia. Results The average time reaching the blood glucose target was (2.8±1.3) d in the perioperative patients with T2DM received intensive CSII treatment, and the overall incidence of hypoglycemia was 15.6%. There were 15 patients in the hypoglycemia group and 81 patients in the non-hypoglycemia group. Compared with the non-hypoglycemia group, the hypoglycemia group was older [(71.1±11.1) years vs (56.0±10.6) years, P=0.000] and had longer course of disease [14.0 (8.8-17.8) years vs 5 (2.8-12.0) years, P=0.017], lower estimated glomerular filtration rate (eGFR) [(78.7±27.5) mL/(min·1.73 m²) vs (106.8±15.0) mL/(min·1.73 m²), P=0.005], and higher incidence of postoperative infection (25% vs 3%, P=0.024). Logistic regression analysis showed that older age (OR=1.172, 95%CI: 1.027-1.091, P=0.012), longer course of disease (OR=1.193, 95%CI: 1.001-1.420, P=0.049) and lower eGFR (OR=0.950, 95%CI: 0.903-0.998, P=0.049) were independent risk factors for hypoglycemia in perioperative T2DM patients treated with CSII. Conclusions The perioperative T2DM patients can quickly achieve the blood glucose target through CSII therapy. Older age, long course of diabetes and low eGFR level are risk factors for hypoglycemia.