不同时限强化胰岛素治疗在危重病人中的应用

目的研究不同时限强化胰岛素治疗对危重症病人应激性高血糖的调控及临床转归的影响。方法对APACHEII评分〉15分、既往无糖尿病病史、需机械通气的危重病人，随机分为3天组、5天组、7天组、对照组，分别给予3天、5天、7天的强化胰岛素治疗，随后给予常规的血糖控制，对照纽则一直给予常规的血糖控制。强化胰岛素治疗控制血糖在4．4—6．1mmol／L，常规血糖控制在4．4～11．1mmol／L。结果216例病人入选，在纳入研究第8一14天，3天组、5天组、7天组的平均血糖水平明显较对照组低，同期每天胰岛素用量也明显比对照组低（p〈0．01）。3天组、5天组、7天组的机械通气时间、MODS发生率、住ICU时间、死亡率均较对照组低，（P〈0．05），但低血糖发生次数明显随着强化胰岛素治疗时间的增长而增多。3天组、5天组与7天组比较．3天组的机械通气时间、住ICU时问均较7天组高（P〈0．01），5天组则与7天组比较，各项指标无统计学差异。结论在危重症病人中，采用5～7天短期强化胰岛素治疗方案，既能降低死亡率，改善预后，又减少了低血糖的发生次数。

DIFFERENT PERIOD OF INTENSIVE INSULIN THERAPY IN CRITICALLY ILL PATIENTS

Objective To investigate the effect and prognosis of intensive insulin therapy in different period on stress - induced hyperglycemia in critically ill patients. Methods We performed a prospective, randomized, con- trolled study involving adults not a known case diabetes, admitted to surgical ICU, mechanical ventilation, whose APACH II score 〉 15. These patients were devided into 3 - day group ,5 - day group ,7 - day group and control group randomly. 3 - day group, 5 - day group, 7 - day group would receive intensive insulin therapy for 3 days, 5 days, 7 days, During these periods the blood glucose were maintained between 4.4 - 6. 1 mmol/1, then they would be given conventional insulin treatment maintaining the blood glucose between 4. I - 11.1 mmol/1, conventional insulin treat- ment was administrated in the control group to maintain the blood glucose between 4. 4 ~ 11.1 mmol/L. Results 216 patients were enrolled in the study. Post intensive insulin therapy from the 8th to 14th day mean blood glucose, insulin consumption in 3 - day group, 5 - day group, 7 - day group were statistically and significantly lower than in the con- trol group. （p 〈0. 01 ）The intensive insulin therapy reduced duration of ventilation and intensive care, rate of MODS and mortality. （p 〈 0.05 ） But hypoglycemia was more frequent in the longer period of intensive insulin therapy. Grea- ter reduction in ventilation time and the duration of intensive care was achieved in 7 - day group than in 3 - day group （p 〈 0.05 ）. No statistical significance was found between 5 - day group and 7 - day group. Conclusion In critically ill patients, short period intensive insulin therapy in 5 to 7 days, can reduce motality and the happening of hypoglycemia, improve the prognosis.