强化胰岛素治疗对严重胸部创伤患者近期预后的影响

目的观察强化胰岛素治疗（IIT）对严重胸部创伤患者预后的影响。方法将42例严重胸部创伤患者（AIS≥3）随机分为IIT组（n=21，血糖控制于4．4～6．1mmol／L）和常规治疗（CIT）组（n=21，血糖控制于10．0～11．1mmol／L）。观察2组治疗后住院期间的病死率，院内感染发生率，机械通气时间、ICU入住、胸腔引流管拔管和白细胞计数下降至正常所需时间。结果2组无住院死亡，无低血糖反应。与CIT组相比，IIT组院内感染发生率、机械通气时间、ICU入住时间、白细胞计数下降至正常所需时间均降低，差异有统计学意义（P〈0．05）；2组在胸腔闭式引流管拔管时间、低血糖反应方面，差异均无统计学意义（P〉0．05）。结论对严重胸部创伤患者IIT治疗可改善预后。

Effect of intensive insulin therapy on short-term prognosis of severe chest trauma patients

Objective To observe the effect of intensive insulin therapy （IIT） on prognosis of severe chest trauma （SCT） pateints. Methods 42 consecutive patients were randomly assigned to 2 groups： IIT group （n = 21 ） and the conventional insulin therapy group （CIT group, n = 21 ）. Blood glucose was maintained at the level of 4. 4 -6. 1 mmol/L in IIT group, and 10. 0 - 11.1 mmol/L in CIT group. The 2 groups were observed in terms of fatality rate during hospital stay, infection rate, the duration of mechanical ventilation, ICU stay length, pleural drainage day and count of neutrophils. Results No death or hypoglycemic reaction happened during hospitalization. Compared to CIT group, infenction rate, mechanical ventilation time, ICU stay length, and the time required for white blood cell to resume normal in IIT group were decreased significantly （ P 〈 0. 05 ）. The difference had no statistical significance between the 2 groups in duration of pleural drainage and incidence of hypoglycemia （ P 〉 0. 05）. Conclusion IIT improves the short-term prognosis of SCT patients.