重症肺炎合并高血糖患者强化胰岛素治疗的探讨

目的 探讨强化胰岛素治疗对重症肺炎合并高血糖患者的疗效及不良反应.方法 对134例重症肺炎合并高血糖患者进行多中心随机对照研究,将其随机分为治疗组(强化胰岛素治疗)和对照组(常规血糖治疗组),比较两组患者ICU病死率、28 d生存率以及相关并发症之间的差异.结果 治疗组与对照组ICU病死率(28.6％与45.6％)、需要持续肾脏替代治疗的急性肾衰竭的发生率(10.4％与24.6％)、需要糖皮质激素治疗的发生率(20.8％与40.4％),治疗组较对照组降低；而治疗组28 d生存率较对照组改善(74.0％与56.1％);同时低血糖(57.1％与24.6％)的发生率高于对照组;但是严重低血糖反应(19.5％与8.8％)和低血糖昏迷(7.8％与3.5％)、低血钾(15.6％与5.3％)的发生率与对照组的差异无统计学意义.结论 强化胰岛素治疗可降低合并高血糖的重症肺炎患者的病死率,提高28 d生存率,同时降低急性肾衰竭的发生率以及减少糖皮质激素的用量;强化胰岛素治疗虽然低血糖的发生率较对照组增加,但是严重低血糖反应和低血糖昏迷、低血钾等不良反应的发生率没有明显的增加.

Therapeutic effect of intensive insulin therapy on severe pneumonia with hyperglycemia

OBJECTIVE To investigate the therapeutic and side effect of intensive insulin therapy on severe pneumonia with hyperglycemia.METHODS Multi-center randomized control trial was carried out for 134 severe pneumonia patients complicated with hyperglycemia.They were randomly divided into the intensive insulin therapy group(maintenance of blood glucose at a level between 80 and150mg/dL) and the conventional therapy group(maintenance of blood glucose at a level between180 and 200 mg/dL).The ICU mortality,28-days survival rate,and side effects of strict insulin therapy were compared between two groups.RESULTS On the one hand,ICU mortality(28.6% vs 45.6%),incidence of acute renal failure needing continouse renal replacement therapy(CRRT)(10.4% vs 24.6%)and incidence of severe septic shock needing glucocorticosteroid therapy(20.8% vs 40.4%)in the strict therapy group were less than that in the conventional group.On the other hand,the 28 days survival rate was higher in the treatment group(74.0%) than in the control group(56.1%);the incidence of hypoglycemia in the intensive insulin therapy group(57.1%)was more than that of the conventional group(24.6%);however,there were no statistical differences in the incidences of apparent hypoglycemia,severe hypoglycemia symptoms(19.5% vs 8.8%) and hypoglycemic coma(7.8% vs 3.5%) and hypokalemia(15.6% vs 5.3%) between two groups.CONCLUSION The intensive insulin treatment can reduce the mortality of patients with severe pneumonia complicated with hyperglycemia and improve 28-days survival rate.At the same time it can reduce the incidence of acute renal failure as well as incidence of severe septic shock needing glucocorticosteroid therapy.Although the incidence of hypoglycemia in intensive insulin therapy group is higher than that of the control group,the incidence of side effects such as severe hypoglycemia,severe hypoglycemia symptoms and hypoglycemia coma,hypokalemia is not significantly increased.