血糖控制与合并应激性高血糖危重症患者预后的关系探讨

目的探讨不同血糖控制水平与重症监护病房(ICU)危重症应激性高血糖患者预后的关系。方法将192例合并应激性高血糖的危重症患者随机分为强化治疗组(目标血糖4.1～6.1mmol/L)57例、胰岛素常规治疗组(目标血糖6.1～8.1mmol/L)76例和对照组(目标血糖8.1～11.1mmol/L)59例。比较3组患者ICU停留时间,院内感染、全身炎性反应综合征(SIRS)、多器官功能衰竭综合征(MODS)、低血糖发生率及病死率。结果强化治疗组和常规治疗组ICU停留时间短于对照组,院内感染、SIRS、MODS发生率及病死率均明显低于对照组,差异均有统计学意义(P<0.05或P<0.01)。胰岛素强化治疗组SIRS、低血糖发生率和病死率均高于常规治疗组,差异均有统计学意义(P<0.05)。结论积极控制危重症患者合并的应激性高血糖有利于改善患者的预后,将目标血糖控制在6.1～8.1mmol/L间获益最大。

Relationship between glycemic control and combined with stress hyperglycemia in critically ill patients prognosis

Objective To study the level of glycemic control in intensive care unit（ICU） patients with stress hyperglycemia in critically ill patients prognosis.Methods ICU combined stress hyperglycemia in critically ill patients with 192 cases,all patients were randomly divided into intensive insulin therapy group（target blood glucose 4.1~6.1mmol/L,57cases）,insulin-conventional treatment group（target blood glucose 6.1~8.1mmol/L,76cases） and control（target blood glucose 8.1~11.1mmol/L,59cases）.Observed three groups of patients ICU stay,incidence of nosocomial infections,systemic inflammatory response syndrome（SIRS） incidence of multiple organ dysfunction syndrome（MODS） incidence of hypoglycemia incidence,mortality and other indicators.Results Insulin conventional treatment group and the intensive therapy group of patients ICU stay,incidence of nosocomial infection,SIRS incidence and mortality rates were significantly lower than the control group,the difference was statistically significant（P〈0.05 or P〈0.01）.SIRS intensive insulin therapy group the incidence of hypoglycemia incidence and mortality rates were higher than the conventional treatment group,the difference was statistically significant（P〈0.05）.Conclusion The positive control in critically ill patients the combined stress of high blood sugar will help to improve the prognosis of patients,the target blood glucose control in the 6.1~8.1mmol/L among the greatest gains.