强化胰岛素治疗对外科重症患者预后的影响

目的 探讨不同血糖控制水平对外科重症患者炎症反应及预后的影响。方法 将188例术后入加强治疗病房（ICU）的APACH Ⅱ〉10分的重症患者随机分为血糖严格控制组（4．4～6．1mmol／L,n=75）、控制组（6．7～8．3mmol／L,n=75）和对照组（10．0～11．1mmol／L,n=38）。使用计算机程序化血糖管理方案控制血糖至目标水平,记录各组术后第1、4、7天血清C反应蛋白（CRP）,呼吸机使用天数、感染发生率、术后红细胞输注量、住ICU费用、住ICU天数、住院病死率等。结果 两血糖控制组红细胞输注及感染发生率均低于对照组（P〈0．05）。与对照组相比,严格控制组呼吸机使用天数及住ICU天数明显缩短（P〈0．05）。在住院病死率、住ICU费用方面,严格控制组与其他两组比较,亦有降低（P〉0．05）。低血糖发生率（〈3．3mmol／L）,严格控制组仍明显高于其他两组（P〈0．05）。结论 应激后控制血糖于正常可能更有利于改善外科重症患者预后,减少住ICU天数与费用。对于确定最佳的目标血糖,还需进一步的相关研究。

Impact of intensive insulin therapy on surgical critically ill patients

OBJECTIVE: To evaluating the effect of different levels of blood glucose control on inflammatory response and prognosis of the patients in surgical intensive care unit (SICU). METHODS: One hundred and eighty-eight patients admitted to SICU were randomly divided into three groups, blood glucose were controlled by insulin infusion. Group A (75 cases): the mean blood glucose (MBG) was maintained at the level of 4.4 - 6.1 mmol/L. Group B (75 cases): MBG was maintained at the level of 6.7 - 8.3 mmol/L. Group C (38 cases): MBG was maintained at the level of 10.0 - 11.1 mmol/L. Blood glucose control was achieved with an effected computerized protocol. The outcome was evaluated by days in ICU, days to wean mechanical ventilation, infection, amount of red blood cellinfusion, hospital mortality and ICU cost. RESULTS: Compared with other groups, hypoglycemia (< 3.3 mmol/L) in Group A was significantly increased (P < 0.05). Compared with Group C, red blood cellinfusion and infection were significantly reduced in Group A and Group B (P < 0.05). Compared with Group C, days of mechanical ventilation and days in ICU in Group A were significantly reduced (P < 0.05). Hospital mortality and ICU cost were reduced in Group A compared with the other groups (P > 0.05). CONCLUSIONS: To maintain blood glucose in normal range with intensive insulin therapy has potential positive impact on SICU patients' outcome and can reduce days in ICU and ICU cost. Further correlation research is needed to determine the best levels of blood glucose in ICU patients.