强化胰岛素治疗对不同预后重症患者血糖波动的影响研究

目的探讨强化胰岛素治疗(IIT)对不同预后重症患者血糖波动的影响。方法选取2011年3～9月入住宁夏医科大学附属总院ICU,且存在应激性高血糖、接受IIT治疗、预计住ICU时间>48h的重症患者。记录患者入住ICU后48h血糖数据、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分及预后情况。按预后分组,分析应用IIT后不同预后患者第1及第2个24h血糖波动的变化。结果共纳入184例患者,APACHEⅡ评分为(15.19±6.73)分,病死率为9.24%(17/184)。生存组第1和第2个24h血糖波动指标(GM、GV)均低于死亡组,且生存组第2个24hGM、GV值低于第1个24h,差异均有统计学意义(P<0.01和P<0.05)。但死亡组GM、GV值在第1个和第2个24h间无明显变化,差异无统计学意义(P>0.05)。结论 IIT可以影响重症患者血糖波动。应用IIT及其他对症支持治疗后,生存患者的血糖波动明显改善,而死亡患者的血糖波动无明显变化。

Study on the influence of blood sugar fluctuation of intensive insulin therapy(IIT) on different prognosis critically ill patients

Objective To study the influence of blood sugar fluctuation of intensive insulin therapy(IIT) on different prognosis critically ill patients.Methods The critically ill patients who were in hospital from 2011.3 to 2011.9.got a stress Stress hyperglycemia and were treated with IIT.And the time of who were staying in ICU>48h were chose as the object.Recorded the blood sugar data.APACHE Ⅱ score and prognosis condition after 48h when patients had stayed in ICU.Classified into 2 groups depend on their outcome.Analyse the change of blood sugar fluctuation of different prognosis critically ill patients who were given IIT in the 1st and 2nd 24h.Results 184 patients were taken into the study.The APACHE Ⅱ score is 15.19±6.73.and the total mortality is 9.24%.The index(GM,GV) of blood sugar fluctuation of survival group was lower than that of the dead group in the 1st and 2nd 24h;the index of blood sugar fluctuation of survival group in the 2nd 24h was lower than that in the 1st 24h.the differences were statistically significant(P<0.01 and P<0.05).But there was no significant difference of GM,GV between the 1st 24h and the 2nd 24h of the dead patients(P>0.05).Conlusion IIT can improve blood sugar fluctuation of critically ill patients.After the IIT,alive patients’blood sugar variation is obveriously improved.but dead patients’ not.