胰岛素强化治疗在ICU危重症高血糖患者中的应用

【目的】观察甘精胰岛素联合门冬胰岛素在ICU危重症高血糖患者中应用的疗效及安全性。【方法】将90例ICU危重症高血糖患者随机分成三组，①中效鱼精蛋白锌胰岛素（NPH）组：加餐前门冬胰岛素；②甘精胰岛素组：给予甘精胰岛素加餐前门冬胰岛素皮下注射；③胰岛素泵（CSⅡ）组：胰岛素泵持续皮下注射，加餐前门冬胰岛素负荷。比较三种治疗方案的降糖效果、达标时间以及发生低血糖的次数。【结果】三种治疗方案均能使血糖达标。NPH组的达标时间为（5．2±1．5）d，而CSⅡ组和甘精胰岛素组血糖达标时间分别为（2．9±0．9）d和（2．8±1．2）d，与NPH组比较差异有显著性（P〈0．05）。NPH组有12人次出现低血糖事件，其中2人次严重低血糖和8人次夜间低血糖事件，CSⅡ组和甘精胰岛素组中低血糖事件以及夜间低血糖事件明显减少，与NPH组比较差异均有显著性（P〈0．01）。【结论】以甘精胰岛素提供基础胰岛素配合餐前门冬胰岛素皮下注射方案治疗伴有高血糖的危重症患者是相对简单、安全、有效的治疗方案。

Study of Intensive Insulin Therapy in Critically Ill Patients with High Blood Glucose in ICU

[Objective] To observe the efficacy and security of insulin glargine combined with insulin aspart in critically ill patients With high blood glucose in ICU. [Methods] Ninety critically ill patients with high blood glucose in ICU were divided into three groups randomly. NPH group received intermediate-acting insulin and preprandial insulin aspart. Insulin glargine group received subcutaneous injection of insulin glargine and preprandial insulin aspart. Insulin pump group received continuous subcutaneous injection of insulin pump combined with preprandial insulin aspart burden. The glucose lowering effect and the time toreaching the standard of blood glucose among three therapeutic regimens were compared. [Results]These three therapeutic regimens could make the blood glucose reach the standard. The time to reaching the standard of blood glucose in NPH group, insulin pump group and insulin glargine group was 5.2±1.5d, 2.9±0.9d and 2.8±1.2d, respectively. There was statistical difference in the time to reaching the standard of blood glucose between insulin pump group, insulin glargine group and NPH group（ P〈0.05）. Twelve cases in NPH group happened hypoglycemia which 2 cases happened serious hypoglycemia and 8 cases happened night hypoglycemia. The incidence of hypoglycemia and night hypoglycemia in both insulin pump group and insulin glargine group was obviously decreased, and there was statistical difference between NPH group and insulin pump group （ P〈0.01）. [Conclusion]Basic insulin glargine combined with subcutaneous injection of preprandial insulin aspart is a simple, safe and effective therapeutic regimen for critically ill patients with high blood glucose in ICU.