危重创伤患者应激性高血糖胰岛素强化治疗

目的探讨强化胰岛素治疗控制血糖与重症监护室（ICU）危重创伤患者机械通气时间、住ICU时间、感染和其他并发症及病死率的关系。方法选择2005年12月至2006年11月和2006年12月至2007年11月入住ICU病房的危重创伤患者各60例，分别为对照组和试验组，试验组采用VaildenBerghe胰岛索强化治疗方案控制血糖在4．0—6．1mmol／L。对照组用常规葡萄糖液1：3加入胰岛素控制清晨空腹血糖在6．9—11．1mmol／L。比较2组患者每日及出ICU时APACHEII评分、机械通气时间、住ICU时间、感染和其他并发症发生率及病死率的差异。结果2组患者APACAEII评分均逐日下降，2组出ICU时APACHEII评分无显著性差异（P〉0。05）。试验组机械通气时间较对照组明显缩短（P〈0.05），感染和其他并发症发生率及病死率均较对照组明显降低（P均〈0．05）。结论对危重创伤患者行强化胰岛素治疗控制血糖在4．0—6．1mmol／L水平是安全有效的，并可以相应改善机体的免疫功能，降低感染及并发症的发生率，改善预后，从而降低病死率；同时可明显缩短患者机械通气时间及住ICU时间。

Effect of intensive insulin therapy on stress-induced hyperglycemia in critical trauma patients

Objective To observe the effect of intensive insulin therapy on improving APACHEII scores,reducing ventilatory support duration and intensive care unit （ ICU ） stay time, reducing incidence of infection and mortality rate of critical trauma patients. Methods Sixty cases of critical trauma as control group from December 2005 to Novermber 2006 and sixty cases as treatment group from December 2006 to Novermber 2007 were compared. Treatment group received intensive insulin therapy; the blood glucose levels were preserved 4.0 mmol/L to 6. 1 mmol/L. Control group received routine insulin therapy;the morning blood glucose levels were preserved 6.9 mmol/L to 11.1 mmol/L. The APACHEII scores, ventilatory support duration, ICU stay time, incidence of infection and mortality rate in two groups were recorded. Results All APACHEII scores of two groups dropped day and day,but there was no significant difference in APACHEII scores at the time of leaving ICU between two groups（ P 〉 0. 05 ）. The ventilatory support duration and ICU stay time were reduced significantly in treatment group（ P 〈 0. 05 ）. The incidence of infection and mortality rate were decreased also in treatment group than those in control group（ all P 〈0. 05 ）. Condusious Intensive insulin therapy maintaining blood glucose between 4.0 mmol/L to 6. 1 mmol/L is security and effficiency,and it might decrease the incidence of infection and mortality rate among criticall trauma patients and reduce ventilatory support duration and ICU stay time in patients with critical trauma.