严重创伤患者早期胰岛素强化治疗对预后的影响  

Effects of early intensive insulin therapy on the prognosis of severe trauma patients

作　　者：赵晓东[1] 马俊勋[1] 闫柏刚[2] 姚咏明[3] 梁华平[4] 闫瑞民[5] 张连阳[6] 黎沾良[7] 邓群[8] 杜俊东[7] 

机构地区：[1]解放军总医院第一附属医院急救部,北京100037 [2]解放军总医院第一附属医院研究室,北京100037 [3]解放军第三军医大学大坪野战外科研究所,重庆400042 [4]重庆第三人民医院急诊科,400014 [5]解放军总医院第一附属医院脑外科,北京100037 [6]解放军第三军医大学大坪三院创伤科,重庆400038 [7]解放军总医院第一附属医院普外科,北京100037 [8]解放军总医院第一附属医院外科监护室,北京100037

出　　处：《中国急救医学》2007年第9期769-772,共4页Chinese Journal of Critical Care Medicine

基　　金：国家重点基础研究发展规划项目(973项目;No.2005CB522602);国家杰出青年基金项目(No.30125020);首都医学发展基金重点项目(No.2003 -2023)

摘　　要：目的探讨胰岛素强化治疗对严重创伤患者预后的影响,研究其对危重患者脏器的保护作用。方法选择64例严重创伤患者,分为胰岛素强化治疗组和对照组,分别给予胰岛素强化治疗和常规治疗,在入院后0、2、4、6、8d留取外周静脉血,同时每日行APACHEⅡ评分,并记录反映脏器功能的生化指标和预后主要指标。结果胰岛素强化治疗实施的安全性良好。强化治疗严格控制血糖后,心功能、肝功能、肾功能不全发生率显著下降,APACHEⅡ评分降低,两组患者死亡率、院内感染发生率比较差异具有统计学意义。结论胰岛素强化治疗能有效降低ICU中危重患者脏器功能不全等并发症的发生,既降低死亡率,又减少感染出现。Objective To study the effect of early intensive insulin therapy on the prognosis of severe trauma patients. Methods 64 severe trauma patients （ISS 〉 20, blood glucose levels were controlled within the range 6 - 8 mmol/L} were randomly divided into intensive insulin therapy group and control group, which were given intensive and routine insulin respectively. Blood samples were obtained at 0, 2, 4, 6 and 8 day after admission to hospital. APACHE Ⅱ score was counted continually, and biological parameters of organ function and main prognostic indexes were recorded. Results The safety of intensive insulin therapy was better. After blood sugar was controlled strictly by intensive therapy, the incidences of acute renal, heart and liver failure reduced obviously. APACHE Ⅱ score decreased. There were obvious differences in mortality and the incidence of nosocomial infection. Conclusion In comparison with control group, intensive insulin therapy can protect organ functions of injured patients in ICU and reduce infection incidence and mortality of organ function failure patients.

关 键 词：严重创伤 胰岛素强化治疗 预后 

分 类 号：R641[医药卫生—外科学]