论文部分内容阅读
目的观察胰岛素强化治疗能否改善重症监护室(ICU)危重患者的预后。方法将116例危重患者随机分为传统治疗组(CT组)和胰岛素强化治疗组(IT组),每4h监测1次床旁血糖。当CT组血糖>11.9mmol/L时,皮下注射中性可溶性胰岛素控制血糖在10.0~11.1mmol/L;当IT组血糖>6.1mmol/L时,皮下注射胰岛素控制血糖在4.4~6.1mmol/L。记录患者ICU住院时间、使用呼吸机时间、气管插管或气管套管留置时间、每日早6时平均血糖、每日提供的平均热量、每日胰岛素用量、每日简化治疗干预评分系统-28(TISS-28)评分、人白细胞DR抗原(HLA-DR)、CD4+/CD8+,死亡、低血糖、肾功能损害(血肌酐>221μmol/L)和高胆红素血症(总胆红素>34.2μmol/L)、输红细胞及发热(口温>38.5℃)例数。结果CT组病死率(44.83%)远远高于IT组(12.07%),差异有显著性(P<0.01);患者ICU住院时间、使用呼吸机时间、气管插管留置时间、每日早6时平均血糖、每日TISS-28评分均明显高于IT组(P<0.05或P<0.01);每日胰岛素用量、HLA-DR、CD4+/CD8+均明显低于IT组(P<0.05或P<0.01)。两组并发症比较,CT组患者发生肾功能损害、输注红细胞及发热例数均明显高于IT组(P均<0.01)。结论胰岛素强化治疗控制危重患者血糖在4.4~6.1mmol/L水平确能降低患者的病死率。
Objective To observe whether intensive insulin therapy can improve the prognosis of critically ill patients in intensive care unit (ICU). Methods One hundred and sixty-six critically ill patients were randomly divided into the traditional treatment group (CT group) and the insulin intensive treatment group (IT group), and the bedside blood glucose was monitored every 4h. When the blood glucose of CT group> 11.9mmol / L, the subcutaneous injection of neutral soluble insulin control blood glucose in the 10.0 ~ 11.1mmol / L; when the IT group blood glucose> 6.1mmol / L, subcutaneous insulin administration of blood glucose control in 4.4 ~ 6.1mmol / L . Record patient ICU length of stay, ventilator time, endotracheal intubation or tracheal tube indwelling time, average daily glucose level at 6 am daily, average daily calorie supply, daily insulin dosage, daily simplified treatment intervention score system -28 (TISS-28), HLA-DR, CD4 + / CD8 +, death, hypoglycemia, renal dysfunction (serum creatinine> 221μmol / L) and hyperbilirubinemia (total bilirubin> 34.2μmol / L), transfusion of red blood cells and fever (mouth temperature> 38.5 ℃) cases. Results The mortality rate in CT group (44.83%) was much higher than that in IT group (12.07%) (P <0.01). The hospital stay time, ventilator time, endotracheal intubation time, (P <0.05 or P <0.01); daily insulin dosage, HLA-DR, CD4 + / CD8 + were significantly lower than those in IT group (P <0.05 or P <0.01) <0.01). Comparing the two groups, renal function impairment, transfusion of red blood cells and fever in CT group were significantly higher than those in IT group (all P <0.01). Conclusion Intensive insulin treatment of critically ill patients with blood glucose levels in the 4.4 ~ 6.1mmol / L indeed reduce the mortality of patients.