胰岛素强化治疗重型颅脑损伤合并糖尿病

目的探讨胰岛素强化治疗对重型颅脑损伤(STBI)合并糖尿病患者的临床疗效及预后的影响。方法选择入住重症监护病房(ICU)既往有糖尿病史的重型颅脑损伤患者80例,随机分为治疗组和对照组,每组40例,治疗组给予7 d胰岛素强化治疗,随后给予常规血糖控制,对照组全程常规血糖控制。强化胰岛素治疗组血糖控制目标为4.4~8.3 mmol/L,常规血糖控制目标为4.4~11.1 mmol/L。结果伤后随访6月按(GOS)评分评价疗效,治疗组恢复良好率较对照组组提高15%,死亡率下降17%(P0.05),ICU住院时间、机械通气时间、院内感染发生率均低于对照组(P0.05)。结论短期胰岛素强化治疗能有效改善重型颅脑损伤合并糖尿病患者的预后,降低ICU内并发症的发生率。

Enhanced insulin treatment for severe traumatic brain injury with diabetes

Objective This study is designed to explore the effect of enhanced insulin therapy on the clinical outcomes of severe traumatic brain injury patients with diabetes.Methods Eighty severe traumatic brain injury patients were enrolled in this study,and assigned randomly to two groups：enhanced insulin group （n =40） and control group （n =40）.Patients in treatment group received 7-day enhanced insulin therapy with the blood sugar goal of 4.4～8.3 mmol/L and followed by regular blood sugar control.Patients of control group received regular insulin therapy with the blood sugar goal of 4.4 ～ 11.1 mmol/L.Results The patients were followed up for 6 months.Therapeutic effect was evaluated according to Glasgow Outcome Scale.The recovery rate of the enhanced insulin group was elevated by 15% compared with the control group.And the mortality rate was reduced by 17% （P〈0.05）.In addition,the intensive care unit （ICU） residency time,mechanical venting time and hospital-onset infection rate of the enhanced insulin group were less than those of control group.Conclusion Short-term enhanced insulin therapy can improve the clinical outcomes of severe traumatic brain injury patients with diabetes and reduce the complications in ICU.