危重患者强化胰岛素治疗的临床研究  

Clinical study of intensive insulin therapy in critically ill patients

作　　者：吴子彬[1] 常智忠[1] 

机构地区：[1]石家庄市第三医院重症监护病房,河北石家庄050011

出　　处：《临床荟萃》2007年第6期400-402,共3页Clinical Focus

摘　　要：目的 研究危重患者强化胰岛素治疗后的临床疗效.方法 选择至少在重症监护病房(ICU)监护2天且既往无糖尿病史的危重病患者96例,收住ICU时血糖水平(14.6±5.5) mmol/L;随机分为治疗组(n=48),给予强化胰岛素治疗,使血糖控制在4.4～6.1 mmol/L,对照组(n=48) 给予常规胰岛素治疗,使血糖控制在8.3～11.1 mmol/L;观察两组患者使用抗生素天数、需用升压药例数、需机械通气例数、机械通气天数、院内感染发生率、应激性溃疡发生率、低血糖发生率、多器官功能衰竭(MOF)发生率、在ICU最后1天急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、住ICU天数及病死率等参数.结果 治疗组在使用抗生素天数、需用升压药例数、需机械通气例数、机械通气天数、院内感染发生率、应激性溃疡发生率、MOF发生率、在ICU最后1天APACHEⅡ、住ICU天数及病死率均明显低于对照组,但低血糖发生率明显高于对照组(P<0.05).结论 对于ICU患者强化胰岛素治疗,将血糖水平控制在4.4～6.1 mmol/L,可改善危重病患者的病情,降低病死率.Objective To study the effect of intensive insulin therapy in critically ill patients.Methods Ninety-six critically ill patients without diabetes participated in the study.These patients stayed in intensive care unit(ICU) for at least two days.The blood glucose of these patients was(14.6±5.5) mmol/L when they entered ICU.The patients were randomly divided into treatment group(n=48) and control group(n=48).Treatment group received intensive insulin therapy,whose blood glucose was controlled at 4.4-6.1 mmol/L.While the control group received routine insulin therapy,whose blood glucose was controlled at 8.3-11.1 mmol/L.Some parameters as follows were observed: the days of using antibiotics,the use of pressor agent,the number of patients requiring mechanical ventilation,the days of mechanical ventilation,incidence rate of nosocomial infection,incidence rate of stress ulcer,morbidity of hypoglycemia,morbidity of multiple organ failure(MOF),Acute Physiology and Chronic Health Evaluation(APACHE)Ⅱ score of the last day in ICU,total days in ICU and mortality.Results Except the morbidity of hypoglycemia was significantly higher in treatment group than that in control group(P<0.05),other parameters such as the days of using antibiotics,the use of pressor agent,the number of patients requiring mechanical ventilation,the days of mechanical ventilation,incidence rate of nosocomial infection,incidence rate of stress ulcer,morbidity of MOF,APACHEⅡ score of the last day in ICU,total days in ICU and mortality were lower in treatment group than those in control group.Conclusion Intensive insulin therapy,keeping blood glucose 4.4-6.1 mmol/L,improves the critically ill patients' condition and reduces the mortality.

关 键 词：危重病 血糖 胰岛素 治疗结果 重症监护 

分 类 号：R73.52[医药卫生—肿瘤]