强化胰岛素治疗在重型颅脑损伤中的临床应用价值探讨

目的：探讨强化胰岛素治疗（intensive insulin therapy，IIT）在重型颅脑损伤（severe traumatic brain injury，sTBI）中的临床应用价值。方法对200例sTBI患者（GCS评分3～8分），入院后随机分为IIT组100例及常规胰岛素治疗（conventional insulin treatment ，CIT）组100例。 IIT组血糖（blood glucose，BG）控制在3.9～6.1 mmol／L，CIT组血糖控制在8.3～10.1 mmol／L。患者入院后即开始采用持续静脉泵入胰岛素对血糖进行控制，记录两组患者平均血糖水平、胰岛素用量、低血糖发生率，于伤后6个月时根据GOS评估法判断疗效（分为良好、中残、重残、植物生存和死亡）。结果治疗期IIT组BG低于CIT组（ P＜0.01），低BG发生率、单位时间胰岛素用量均高于CIT组（ P＜0.05或P＜0.01）。伤后6个月，两组在良好、中残、重残、植物生存和死亡例数比较差异无统计学意义（ P＞0.05）。结论强化胰岛素治疗并不能改善sTBI的预后，且增加了低BG发生率，血糖控制在8.3～10.1 mmol／L是比较理想的水平。

Clinical application value of intensive insulin therapy in severe traumatic brain injury

Objective To discuss the clinical application value of intensive insulin therapy （ IIT） in severe traumatic brain injury（sTBI）.Methods Two hundred patients with sTBI （GCS 3~8） were randomly divided into the intensive insulin therapy group（IIT,n=100 cases）and the conventional insulin treatment group （CIT,n=100 ca-ses） .IIT group′s blood glucose （ BG） was controlled in 3.9~6.1 mmol/L, CIT group′s blood glucose was controlled in 8.3~10.1 mmol/L.The patients after admission were treated using continuous intravenous infusion of insulin to control blood glucose .The average blood glucose levels , insulin dosage , incidence of hypoglycemia in two groups were recorded .Six months after injury , the efficacy was evaluated according to GOS valuation method including 5 grades：good, moderate disability, severe disability, vegetative state, and death.Results During treatment BG in IIT group was lower than that in CIT group （ P〈0.01 ） , the incidence of hypoglycemia , average hourly insulin dosage in IIT group were higher than those in CIT group （ P〈0.05 or P〈0.01 ） .After 6 months there were no statistically signifi-cant difference between the two groups in the efficacy including good , moderate disability , severe disability , vegeta-tive state, and death（P＆gt;0.05）.Conclusion IIT does not improve the prognosis of patients with sTBI , but increase the incidence of hypoglycemia , blood glucose is controlled in 8.3-10.1 mmol /L is ideal.