Article(id=1322924581920579766, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322924415817757501, articleNumber=null, orderNo=null, doi=10.12102/j.issn.1009-6493.2026.17.028, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1764086400000, receivedDateStr=2025-11-26, revisedDate=1784044800000, revisedDateStr=2026-07-15, acceptedDate=null, acceptedDateStr=null, onlineDate=1793339399079, onlineDateStr=2026-10-30, pubDate=1788969600000, pubDateStr=2026-09-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793339399079, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793339399079, creator=13701087609, updateTime=1793339399079, updator=13701087609, issue=Issue{id=1322924415817757501, tenantId=1146029695717560320, journalId=1220038315760373764, year='2026', volume='40', issue='17', pageStart='2961', pageEnd='3152', issueExtLink='null', onlineDate='null', pubDate='1788969600000', pubDateStr='2026-09-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793339359478, creator='13701087609', updateTime=1793343089343, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322940060072542250, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322924415817757501, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322940060072542251, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322924415817757501, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=3144, endPage=3148, ext={EN=ArticleExt(id=1322924582130294967, articleId=1322924581920579766, tenantId=1146029695717560320, journalId=1220038315760373764, language=EN, title=Application progress on advanced hybrid closed-loop therapy in the care of patients with diabetes, columnId=1220689485315101342, journalTitle=Chinese Nursing Research, columnName=Review Articles, runingTitle=null, highlight=null, articleAbstract=

This paper summarized the application forms and effects of advanced hybrid closed-loop therapy technology in blood glucose management of patients with diabetes, analyzed current challenges,and proposed recommendations,aiming to provide theoretical basis and practical guidance for clinical nursing practice.

, authors=Yinghua ZHU1, Defeng CHEN2, Yang YANG1, Mengxin HE3, Jiabao LI3, Yaokai XU1, Yueyu LIANG1, Qiuyue WU1, Wenning BIAN3, authorsList=Yinghua ZHU, Defeng CHEN, Yang YANG, Mengxin HE, Jiabao LI, Yaokai XU, Yueyu LIANG, Qiuyue WU, Wenning BIAN, authorCompany=null, correspAuthors=Defeng CHEN, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322924582407119032, articleId=1322924581920579766, tenantId=1146029695717560320, journalId=1220038315760373764, language=CN, title=高级混合闭环疗法在糖尿病护理中的应用进展, columnId=1220689485482873504, journalTitle=护理研究, columnName=科研综述, runingTitle=null, highlight=null, articleAbstract=

总结高级混合闭环疗法技术人在糖尿病病人血糖管理中的应用形式、效果,分析现阶段存在的问题并提出建议,旨在为临床护理实践提供理论依据和实践指导。

, authors=朱英华1, 陈德凤2, *, *, 杨扬1, 何梦欣3, 李佳宝3, 徐要凯1, 梁悦语1, 伍秋月1, 卞文宁3, authorsList=朱英华, 陈德凤, 杨扬, 何梦欣, 李佳宝, 徐要凯, 梁悦语, 伍秋月, 卞文宁, authorCompany=null, correspAuthors=陈德凤, authorNote=

朱英华,硕士研究生在读

, correspAuthorsNote=
陈德凤,E-mail:
CHEN Defeng, E-mail:
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朱英华,硕士研究生在读

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朱英华,硕士研究生在读

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高级混合闭环疗法在糖尿病护理中的应用进展
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朱英华 1 , 陈德凤 2, *, * , 杨扬 1 , 何梦欣 3 , 李佳宝 3 , 徐要凯 1 , 梁悦语 1 , 伍秋月 1 , 卞文宁 3
护理研究 | 科研综述 2026,40(17): 3144-3148
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护理研究 |科研综述 2026 , 40 (17) : 3144 -3148
高级混合闭环疗法在糖尿病护理中的应用进展
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朱英华1, 陈德凤2, *, * , 杨扬1, 何梦欣3, 李佳宝3, 徐要凯1, 梁悦语1, 伍秋月1, 卞文宁3
作者信息
  • 1右江民族医学院护理学院,广西 533000
  • 2广西壮族自治区人民医院
  • 3广西中医药大学护理学院
通讯作者:
陈德凤,E-mail:
CHEN Defeng, E-mail:
作者简介:

朱英华,硕士研究生在读

Application progress on advanced hybrid closed-loop therapy in the care of patients with diabetes
Yinghua ZHU1, Defeng CHEN2 , Yang YANG1, Mengxin HE3, Jiabao LI3, Yaokai XU1, Yueyu LIANG1, Qiuyue WU1, Wenning BIAN3
Affiliations
  • 1School of Nursing, Youjiang Medical University for Nationalities, Guangxi 533000 China
  • 2The People's Hospital of Guangxi Zhuang Autonomous Region
  • 3School of Nursing, Guangxi University of Chinese Medicine
出版时间: 2026-09-10 doi: 10.12102/j.issn.1009-6493.2026.17.028
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总结高级混合闭环疗法技术人在糖尿病病人血糖管理中的应用形式、效果,分析现阶段存在的问题并提出建议,旨在为临床护理实践提供理论依据和实践指导。

糖尿病  /  高级混合闭环疗法  /  胰岛素泵  /  持续葡萄糖监测  /  血糖管理  /  护理  /  综述

This paper summarized the application forms and effects of advanced hybrid closed-loop therapy technology in blood glucose management of patients with diabetes, analyzed current challenges,and proposed recommendations,aiming to provide theoretical basis and practical guidance for clinical nursing practice.

diabetes mellitus  /  advanced hybrid closed-loop therapy  /  insulin pump  /  continuous glucose monitoring  /  blood glucose management  /  nursing  /  review
朱英华, 陈德凤, 杨扬, 何梦欣, 李佳宝, 徐要凯, 梁悦语, 伍秋月, 卞文宁. 高级混合闭环疗法在糖尿病护理中的应用进展. 护理研究, 2026 , 40 (17) : 3144 -3148 . DOI: 10.12102/j.issn.1009-6493.2026.17.028
Yinghua ZHU, Defeng CHEN, Yang YANG, Mengxin HE, Jiabao LI, Yaokai XU, Yueyu LIANG, Qiuyue WU, Wenning BIAN. Application progress on advanced hybrid closed-loop therapy in the care of patients with diabetes[J]. Chinese Nursing Research, 2026 , 40 (17) : 3144 -3148 . DOI: 10.12102/j.issn.1009-6493.2026.17.028
糖尿病(diabetes mellitus,DM)是造成人类死亡和残疾的四大慢性病之一[1]。国际糖尿病联盟数据显示,2021年全球成人糖尿病患病率为10.5%,约5.37亿例,预计到2045年,患病率将上升到12.2%,患病人数将达到7.83亿例[2]。数据显示,18岁以上糖尿病人数已超过8.28亿例,而中国病人数已经突破1.4亿例,位居世界第2位[3]。与此同时,全球糖尿病疾病经济负担不断增加,2021年全球用于治疗糖尿病的医疗支出总额约1万亿美元,2017年我国与糖尿病相关的医疗保健费用为1 100亿美元[4]。血糖监测是糖尿病管理的重要环节。而传统的血糖监测方法包括糖化血红蛋白监测、自我血糖监测和动态血糖监测,可能存在无法反映病人的血糖波动特点及低血糖风险,多次针刺采血给病人带来痛感和不便,难以反映病人血糖变化全貌,血糖数值存在读数误差等问题[5]。高级混合闭环疗法(advanced hybrid closed-loop therapy,AHCL)是将胰岛素治疗剂量的调整完全交由自动系统完成,算法自动调整基础胰岛素需求,并每天适应胰岛素剂量,具有精准控制、安全、有效和灵活的特点,对糖尿病病人血糖值控制效果显著,同时减轻了医护人员管理糖尿病的负担[6]。目前,高级混合闭环疗法系统在国外糖尿病病人中应用广泛,但国内该领域鲜有相关研究。因此,对高级混合闭环疗法在糖尿病病人中的应用现状进行综述,以期为我国护理人员对糖尿病病人的进一步护理和管理提供参考。
高级混合闭环疗法作为糖尿病病人在血糖管理领域方面的一项创新性技术,其概念的提出源自对传统糖尿病治疗模式的创新。在20世纪70年代,随着持续皮下胰岛素输注技术的问世,研究人员首次尝试通过外部设备模拟人体胰岛素分泌功能,这为后续系统的开发奠定了基础[7]。在医学上最早、最成熟的应用是胰岛素泵与持续葡萄糖监测(continuous glucose monitoring,CGM)构成自适应闭环系统。目前,随着胰岛素泵和CGM技术的进步,治疗模式从需手动调整胰岛素输送的传感器增强型泵疗法转变为能自动调整基础胰岛素输注的混合闭环胰岛素泵疗法[8]。高级混合闭环疗法系统目前代表了胰岛素血糖管理领域的前沿技术。美敦力MiniMed 780G高级混合闭环疗法系统整合了三大核心组件:持续皮下胰岛素输注泵、CGM传感器及智能控制算法[9]。在自动模式下,该算法根据传感器测量的组织间液葡萄糖水平动态调整基础胰岛素输注速率,并在需要时自动输注校正剂量。餐时大剂量仍需用户手动输入。该项技术可使医护人员对糖尿病病人的自身健康做出更明智的选择,并为促进预防、维持血糖正常提供新的选择。目前,利用高级混合闭环疗法为糖尿病病人实现更为高标准的护理服务已成为当务之急。
高级混合闭环疗法主要是通过持续血糖监测算法设备、胰岛素泵进行无线互连,利用CGM反馈的血糖值进行精确计算,实时调整胰岛素的输注速率,从而使糖尿病病人达到最佳的血糖控制状态[10]。CGM是由葡萄糖感应器、线缆、血糖记录器、信息提取器和分析软件构成。感应器由半透膜、葡萄糖氧化酶和微电极组成,借助助针器植入受检者腹部皮下,并与皮下组织间液中的葡萄糖发生化学反应产生电信号[11]。Salima等[12]研究证实了高级混合闭环疗法在孕期的安全性和有效性,与标准胰岛素治疗相比,该疗法可改善病人夜间血糖水平状态,并降低低血糖的发生风险,从而提高病人的治疗满意度。Katrien[13]等研究发现,对于一开始就采取更严格血糖控制的孕妇而言,高级混合闭环疗法虽未改善总体血糖达标时间,但能缩短夜间血糖达标时间,进而缩短血糖低于目标范围的时间,并提高治疗满意度。这些数据表明,美敦力MiniMed 780G胰岛素泵可在孕期安全使用,与标准胰岛素治疗相比,还能带来一些额外益处,如新生儿低血糖转重症监护室与妊娠期体重过度增长均明显减少。综上,通过借助高级混合闭环疗法,护理人员得以动态观察病人的血糖波动状况,进而为制定合理的护理方案提供参考。
以精准的血糖监测为基础,高级混合闭环疗法系统可以通过对算法控制器来调整胰岛素输注剂量,这对于病人控制血糖和治疗具有重要意义。具体来说,该系统主要包含动态血糖监测系统、胰岛素泵以及算法控制器3个核心组件。其中,算法控制器是关键环节,其通过模型预测控制、比例积分微分或模糊逻辑控制等策略对胰岛素输送进行优化[7]。例如,模型预测控制可根据未来的血糖读数调整胰岛素输送量,而比例积分微分则根据实时血糖值将基础胰岛素输送量调整至目标血糖范围。Laura等[14]发现通过使用高级混合闭环疗法系统在病人中实现并维持血糖控制效果进行回顾性评估,在激活自动模式后的短短14 d内,该系统就迅速改善血糖控制状况,实现并保持最佳血糖控制效果方面的有效性,且这种效果在长期随访中得以持续。此外,Prati等[15]研究显示,在被随机分配接受治疗组中在6个月时,平均糖化血红蛋白下降1.54%,在高级混合闭环疗法组从9.00%下降到7.32%,在每日多次注射胰岛素加胰岛素生长调节剂P组从9.07%下降到8.91%(基于模型的差异为1.42%,P<0.001)。临床试验表明病人使用闭环系统(SmartGuradTM技术算法)的病人其血糖达标时间(time in range,TIR)增加,时间每天增加3.4 h,糖化血红蛋白下降0.1%;病人使用自动模式时间每天增加8.6 h,TIR增加5%[16]。SmartGuradTM技术算法通过调节基础胰岛素输送,提高葡萄糖达标时间[17]。高级混合闭环疗法系统通过自动化调节,在不降低推荐目标值的前提下[即夜间胰岛素抵抗率时间低于范围(time below range,TBR)低于4%、总胰岛素分泌率TIR超过70%],有效控制了血糖波动幅度,同时减轻了病人的胰岛素用药负担[18]。这种智能化的胰岛素输注剂量机制不仅可减少病人的需求,还可有效改善其低血糖的临床症状,促进糖尿病病人的健康。
高级混合闭环疗法能够根据病人的动态血糖变化和个体的基本情况,推送个性化的饮食建议,从而实现更为精准的饮食管理。Petrovski等[19]研究表明,采用预设固定碳水化合物含量的简化餐食告知方案可使67%固定组病人达到目标血糖在TIR,但精确碳水化合物计数组在此指标上仍存在6.8%的优势。Barbara等[20]对83名受试者评估显示,启用自动模式3个月和6个月后,TIR增加超过70%并保持稳定,血糖管理指数和糖化血红蛋白下降;基础胰岛素比例降低,餐时胰岛素比例增加;每日餐次和每日胰岛素总剂量/体重增加,但体质指数和碳水化合物摄入量无变化。Minsky等[21]研究证实,在成人高级混合闭环疗法系统应用中,采用基于餐量使用固定碳水估算值至多3倍剂量的简化推注策略,不仅能有效达成血糖控制目标,且在血糖、高血糖时间及变异系数上可能优于精确碳水化合物计数法。Shalit等[22]研究证明,高级混合闭环疗法系统在病人漏报餐食时仍能维持血糖稳定,这为存在膳食管理困难或糖类化合物评估能力受限的病人确立了预期疗效。综上,高级混合闭环疗法这种个性化的饮食管理策略不仅有助于改善病人的血糖控制效果,而且还能增强自我管理能力,最终实现更好的健康结局。
高级混合闭环疗法可以对糖尿病病人的血糖进行实时监督及指导,使得病人深入理解并掌握运动相关知识及自身状况,自觉规范健康行为。运动是糖尿病管理的重要方面,了解如何更好地使用自动胰岛素输注系统帮助管理运动期间的血糖水平对病人的血糖安全、长期健康和生活质量至关重要[23]。具体而言,Breton等[24]发现病人还需学会在运动前、中、后期运用临时目标等特定功能,并了解剧烈运动可能暂时降低传感器读数准确性。另一方面,Ekhlaspour等[25]发现,高级混合闭环疗法系统在1型糖尿病病人体力活动期间维持血糖在目标范围内时长方面展现出良好前景。例如,Da Prato等[26]开展了一项开放标签、随机交叉研究,以评估特定高级混合闭环疗法系统在成人病人中的使用效果,结果显示最大限度减少餐后中等强度有氧运动(postprandial moderate-intensity aerobic activity,AER)与高强度间歇训练(high-intensity interval training,HIIT)期间以及次日夜间高血糖和低血糖的时间;此外,HIIT组的基础胰岛素自动暂停时间明显长于AER组(33 min与20 min,P=0.021),这可能是因为HIIT后血糖水平上升较慢,反映出肌肉摄取葡萄糖与肝脏生成葡萄糖之间的平衡状态不佳。Morrison等[27]研究显示,在使用高级混合闭环疗法系统的7名1型糖尿病病人中,早晨40 min中等强度运动比晚上中等强度运动平均血糖水平更高。此外,研究显示,这种综合干预模式不仅能够提高病人的肌肉力量和机体功能,还能促进胰岛素对葡萄糖的摄取,改善机体糖脂代谢紊乱,提高血糖控制效果,从而改善其整体健康状况[28]。未来,医护人员应利用高级混合闭环疗法系统为糖尿病病人制订精准、个性化的运动管理方案,并持续监测糖尿病病人的血糖与调整运动,提高糖尿病病人运动依从性与生活质量。
高级混合闭环疗法系统的传感器失灵、数据传输中断和胰岛素泵堵塞是十分普遍的问题,亦是目前高级混合闭环疗法面临的难题之一。传感器失灵通常由生物相容性问题、电极老化或外部环境干扰引起,而数据传输中断则可能与通信模块故障或信号覆盖不足有关[7]。另外,胰岛素泵堵塞则多因导管折叠、结晶或气泡残留等因素造成,进而影响正常的输注[29]。因此,传感器的灵敏度需要进一步提高;同时,设备的体积应更小、重量更轻,佩戴起来更加舒适便捷[30]。电池续航能力也应该大幅增强,从而解决数据中断的问题。其次,吴巧敏等[31]在导管堵塞方面,除了寻找新型的留置针头材料,使用抛弃管路的敷贴式或特殊的材料——葡萄糖敏感凝胶制造的胰岛素泵,以尽可能地降低输注过程中的阻塞风险。最后,医护人员应该通过建立完善的设备管理制度,加强病人对设备维护与校准的意识,从而构建安全、可靠的医疗环境。
高级混合闭环疗法通过动态调节胰岛素输注改善了糖尿病病人的血糖控制效果[32]。但如何提高糖尿病人群对高级混合闭环疗法的使用依从性仍然是目前面临的困难。一项研究表明,许多病人担心设备操作复杂或出现故障,从而产生抵触情绪[33]。首先是技术复杂性与认知超负荷,高级混合闭环疗法系统要求用户掌握报警管理、碳水化合物计算和故障排除等复杂技能。特别是对于技术素养较低或年长的病人,这种持续的学习需求可能导致认知超负荷,从而引发挫败感和系统弃用[34]。同时,科技警报亦可能引发额外的焦虑情绪升级,进而产生扰人效应,夜间时段尤为明显[35]。另外,糖尿病病人需要长期佩戴输注贴和传感器,可能会引起皮肤瘙痒、过敏或不适感,这可能会造成身体不适或者心理压力负担过大。由此可见,设备可能让一些病人产生病耻感或感到与他人不同,影响其身体形象和社交活动,最终导致他们减少设备使用[36]。持续的支持(如定期复诊、在线资源等)对于巩固知识和解决新出现的问题至关重要[37]。其次,需要优化系统报警装置与设置个性化目标;加强心理支持;将认知行为疗法和动机性访谈融合到护理中,帮助病人克服焦虑、恐惧的心理,建立对系统的信任,并度过从“管理者”到“监督者”的角色转变。最后,医护人员应普及该系统的重要性,鼓励病人使用该监测设备,定期进行糖尿病科普知识宣教,提高病人的治疗依从性,改善病人的自我管理水平[38]。
虽然高级混合闭环疗法在糖尿病病人中的应用前景广阔,能有效降低血糖并维持稳定,但在治疗方面仍面临诸多挑战,智能设备的研发和制造成本较高;对于医疗机构和病人而言都是一笔不小的经济支出。首先,初始硬件成本极其高昂,包括智能胰岛素泵和CGM传感器的购置费用。在低中等收入国家以及农村地区,这些服务在维持病人的定期随访方面确实发挥了作用,但并不总是能有效维持良好的血糖控制水平[39]。Verbeeten等[40]研究证实,带有低血糖阈值暂停功能的胰岛素泵联合系统可以缓解1型糖尿病儿童和父母的低血糖恐惧水平。但其治疗费用高昂导致尚未在临床中推广。未来可以考虑将高级混合闭环疗法纳入医疗报销范畴,同时建立新型智能产品的定价与补贴机制,将新兴技术的临床应用落地到惠民政策中,推动高级混合闭环疗法在临床的广泛应用。
本研究对高级混合闭环疗法进行概述, 总结其在糖尿病病人中的应用情况,并提出相关建议,为病人血糖管理提供了科学依据,使高级混合闭环疗法系统能更有效在糖尿病病人血糖管理中实施并推广。但目前,该项技术在我国糖尿病病人血糖管理中的应用研究与临床实践尚处于起步阶段,面临系统稳定性、病人依从性、经济等多重挑战,有待深入探究,在一定程度上影响了其发展。未来,应通过完善相关医保政策、建立产品的定价与补贴机制等,满足用户的需求,探索更加符合我国国情、高效、便捷的糖尿病护理方案,着力推动高级混合闭环疗法在糖尿病护理中的广泛应用,为病人提供更优质的护理服务。

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doi: 10.12102/j.issn.1009-6493.2026.17.028
  • 接收时间:2025-11-26
  • 首发时间:2026-10-30
  • 出版时间:2026-09-10
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  • 收稿日期:2025-11-26
  • 修回日期:2026-07-15
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    1右江民族医学院护理学院,广西 533000
    2广西壮族自治区人民医院
    3广西中医药大学护理学院

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total species (%)
属
Genus
种数
Number of
species
占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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