甘精胰岛素控制危重患者血糖的疗效观察

目的观察用甘精胰岛素调控重症监护病房患者的血糖水平,以探讨其对预后的影响。方法选择重症监护病房患者194例,根据胰岛素种类和目标血糖的不同,分为甘精胰岛素组1(n=48例)和常规胰岛素组1(n=46例),目标血糖为6.1~8.3 mmol/L;甘精胰岛素组2(n=49例)和常规胰岛素组2(n=51例),目标血糖为4.4~6.1 mmol/L。比较两组患者低血糖的发生和各项预后指标的差异。结果当目标血糖相同,甘精胰岛素组与常规胰岛素组的感染发生率、住院时间和ICU滞留时间、住院费用、住院病死率均无显著差异(P>0.05)。但目标血糖6.1~8.3 mmol/L时常规胰岛素组有4例(8.7%)患者并发了低血糖,甘精胰岛素组无低血糖发生,两组间有显著性差异(P<0.01);目标血糖4.4~6.1 mmol/L时常规胰岛素组有8例(15.7%)患者并发了低血糖,甘精胰岛素组1例(2%),两组间有显著性差异(P<0.01)。结论甘精胰岛素控制血糖对危重患者预后影响与常规胰岛素相仿,但甘精胰岛素能显著降低低血糖的发生率。

Observation on therapeutic effect of insulin therapy in critically ill patients with glargine

Objective To evaluate the effect of different levels of blood glucose control on prognosis of the patients in intensive care unit(ICU) with glargine.Methods One hundred and ninety-four patients admitted to ICU were randomly divided into four groups.Blood glucose was controlled by insulin infusion.The blood glucose was maintained at the level of 6.1～8.3 mmol/L in group 1(94 cases),including glargine insulin group 1(48 cases) and normal insulin group 1(46 cases).In group 2(100 cases),including glargine insulin group 2(49 cases) and normal insulin group 2(51 cases),blood glucose was maintained at the level of 4.4～6.1 mmol/L.The outcome was evaluated by systemic and local complications,hospital mortality,hypoglycemia.Results Compared with normal insulin group,hospital mortality and infection in glargine insulin group were not significantly different(P>0.05).But hypoglycemia in glargine insulin group significantly reduced.(respectively,0 vs 8.7%,2% vs 15.7%,P<0.01).Conclusion Hospital mortality and infection were not significantly different between glargine insulin group and normal insulin group.But hypoglycemia in glargine insulin group very significantly reduced.