危重病患者胰岛素强化治疗不同目标血糖值对预后影响的临床研究

目的探讨危重病患者胰岛素强化治疗不同目标血糖值对预后的影响。方法选择入住ICU既往无糖尿病史的危重患者168例,随机分为胰岛素强化治疗Ⅰ组、Ⅱ组和对照组,每组56例。Ⅰ组血糖控制在4.4～6.1 mmol/L,Ⅱ组6.2～8.0 mmol/L,对照组10.0～11.1 mmol/L。观察3组患者ICU住院时间、机械通气天数、院内感染发生率、病死率、脏器功能不全率、日平均胰岛素用量、日平均血糖值、低血糖发生率及ICU最后1 d APACHEⅡ评分等参数。结果Ⅰ、Ⅱ组ICU住院时间、机械通气天数、ICU最后1 d APACHEⅡ评分、院内感染发生率、病死率及脏器功能不全率均明显低于对照组(P<0.05或P<0.01),而Ⅰ组和Ⅱ组以上观察指标差异无统计学意义(P>0.05);低血糖(<3.8 mmol/L)发生率Ⅰ组高于Ⅱ组、对照组(P<0.05或P<0.01),Ⅱ组和对照组低血糖发生率差异无统计学意义(P>0.05)。结论对于ICU危重患者强化胰岛素治疗,将血糖水平控制在4.4～8.0 mmol/L可改善临床疗效,降低病死率及低血糖的发生率。

Effect of intensive insulin therapy of different target blood glucose on prognosis in critically illness patients

Objective To investigate the effect of intensive insulin therapy of different target blood glucose on prognosis in critically illness patients. Methods One hundred and sixty eight patients without diabetes in ICU were randomly divided into intensive insulin group l, group lI and control group（ n = 56 for each group）. The blood glucose in group Ⅰ was controlled at 4.4 - 6.1 mmol/L and the blood glucose in group Ⅱ was controlled at 6.1 - 8.0 mmol/L, while the control group received routine insulin therapy, whose blood glucose was controlled at 10.0 - 11.1 mmol/L. Parameters as follows were observed and recorded： duration time in the ICU, the lasting days of using mechanical ventilation, acute physiology and chronic heahh evaluation（APACHE） Ⅱ score of the last day in ICU, the incidences of infection in hospital, the morbidity of muhiple organ failure, mortality ,the morbidity of hypoglycemia, the average daily blood glucose and the dosage of required insulin per day. Results All the parameters except the morbidity of hypoglycemia and the dosage of required insulin per day were significantly lower in group Ⅰ and Ⅱ than those in control group（ P 〈0.05 or P 〈0.01 ） ; the dosage of required insulin per day and the morbidity of hypoglycemia were significantly higher in group l than those in group Ⅱ and control group（ P 〈0.05, P 〈0.01 ） ,and the other parameters were no significant difference in group I and group Ⅱ （ P 〉 0.05 ） ; the morbidity of hypoglycemia had no significant difference between group Ⅱ and control group（ P 〉0.05）. Conclusion Intensive insulin therapy and maintaining blood glucose at 4.4 - 8.0 mmol/L can improve the effect of treatment, reduces the mortality and the morbidity of hypoglycemia.