不同疗程胰岛素强化治疗危重病患者应激性高血糖的临床观察

目的探讨胰岛素强化治疗不同疗程对危重病患者应激性高血糖的调控及临床转归的影响。方法 选择入住ICU既往无糖尿病史的危重病患者156例,随机分为3组,每组52例,对照组始终给予常规血糖控制,控制血糖在4.4～11.1 mmol/L;7 d组、14 d组分别给予7 d、14 d的强化胰岛素治疗,随后给予常规的血糖控制,控制血糖在4.4～8.3 mmol/L。结果在强化胰岛素治疗期间,7 d组、14 d组胰岛素用量高于对照组,血糖水平低于对照组(P<0.01),强化治疗停止后第15～21天,7 d组、14 d组的平均血糖水平及胰岛素用量均明显低于对照组(P<0.01);7 d组、14 d组的ICU住院时间、机械通气天数、院内感染发生率、MODS发生率及病死率均明显低于对照组(P<0.05或P<0.01),而7 d组和14 d组比较,上述观察指标差异无统计学意义(P>0.05);低血糖的发生率随着胰岛素强化治疗时间的增长而增高,但差异无统计学意义(P>0.05)。结论在危重病患者中,采用7d短期胰岛素强化治疗,能达到同强化胰岛素治疗方案相同或相似的控制目的 ,既改善预后,又减少低血糖的发生率。

Clinical study of different course intensive insulin therapy on stress hyperglycemia in severe patients

Objective To investigate the effect of different course of intensive insulin therapy on stress hyperglycemia in severe patients.Methods One hundred and fifty six patients without diabetes in ICU were randomly divided into three groups (n = 52 for each group).Regular insulin treatment was administrated in control group to maintain the blood glucose between 4.4～11.1mmol/L.7-day group,14-day group were received intensive insulin therapy for 7 days,14 days.During these periods, the blood glucose were maintained between 4.4～8.3 mmol/L.Then they were given regular insulin treatment maintaining the blood glucose between 4.4 ~ 11.1 mmol/L.Results During intensive insulin therapy,insulin consumption in 7-day group,14-day group were significantly higher than in control group,while the blood glucose were lower than in control group (P < 0.01).After finish intensive therapy,mean blood glucose,insulin consumption in 7-day group,14-day group were significantly lower than that in control group(P <0.01).The duration in ICU,the period of mechanical ventilation,the incidence of nosocomial infections,the rates of MODS and mortality were significantly lower in 7-day group and 14-day group than in control group.(P <0.05 or P <0.01 ).No statistical significance was found between 7-day group and 14-day group(P > 0.05 ).Though the incident of hypoglycemia was more frequently occurred in the longer period of intensive insulin therapy,but there was no statistical difference(P >0.05).Conclusion In servere illness patients,short course intensive insulin therapy in 7 days could achieve the same or similar effect as intensive insulin therapy,it would be helpful for improving the prognosis and reduces the morbidity of hypoglycemia.