强化胰岛素治疗危重症患者应激性高血糖的临床研究

目的观察强化胰岛素治疗在危重症患者应激性高血糖中的临床研究。方法截取本院ICU2010年2月～2012年10月100例高血糖危重症患者，按照强化胰岛素治疗方案来控制血糖，随机分为强化治疗组及常规治疗组，其强化治疗组（50例）给予强化胰岛素治疗，强化治疗组血糖维持在4．4～6．1mmol／L；常规治疗组（50例）给予常规胰岛素治疗，常规治疗组血糖控制在10．0—11．1mmol／L。治疗4周后，观察两组患者使用呼吸机的天数、使用抗生素的天数、住院时间、院内感染发生率、病死率。结果强化治疗组中使用呼吸机的天数为（9．4±3．8）d，使用抗生素天数为（13．0±2．5）d，住院时间为（15．0±3．2）d，院内感染率（18．0％）、病死率（15．0％）均明显低于常规治疗组，差异有统计学意义（P〈0．05）。结论当危重症患者出现应激性高血糖时，强化胰岛素治疗可控制高血糖并改善危重症患者的预后，降低感染发生率和病死率，提高临床疗效。

Clinical study of intensive insulin therapy on critically ill patient with stress hyperglycemia

Objective To observe the effect of intensive insulin therapy on critically ill patient with stress hyper- glycemia. Methods Based on insulin therapeutic schedule in controlling blood glucose, 100 cases of critically ill pa- tients with hyperglycemia, who hospitalized in ICU of our hospital from February 2010 to October 2012, were randomly divided into intensive treatment group and conventional treatment group. The intensive treatment group （50 cases） was treated with intensive insulin therapy, and it maintained blood glucose between 4.4 to 6.1 mmol/L. The conventional treatment group （50 cases） received conventional insulin therapy, and it maintained blood glucose between 10.0 to 11.1 mmol/L. After 4 weeks of treatment, ventilator supporting time, duration on antibiotic, length of stay, incidence rate of nosocomial infection and mortality in two groups were observed. Results In intensive treatment group, ventilator sup- porting time was （9.4±3.8） d, the duration on antibiotic was （13.0±2.5） d, the length of stay was （15.0±3.2） d, the inci- dence rate of nosocomial infection was 18.0%, and the mortality rate was 15.0%. Those were significantly lower than that in conventional treatment group, the difference was statistically significant （P 〈 0.05）. Conclusion When critically ill patient suffered from stress hyperglycemia, intensive insulin therapy can control hyperglycemia and improve their prognosis. It also can reduce the incidence of infection and mortality, improve clinical efficacy.