危重患者应激性高血糖胰岛素强化治疗临床观察  

Intensive insulin therapy on stress hyperglycemia in critical ill patients

作　　者：程春瑞[1] 欧书钦[1] 马渝[1] 文玉明[1] 

机构地区：[1]重庆市急救医疗中心,400014

出　　处：《重庆医学》2010年第13期1683-1684,共2页Chongqing medicine

摘　　要：目的观察入住ICU应激性高血糖的危重患者,经胰岛素治疗后,血糖降至正常和略高于正常时的临床结局。方法 105例入住ICU的患者,既往无糖尿病史,入院血糖超过8.0 mmol/L,静脉输注胰岛素。根据控制目标血糖4.4~6.1 mmol/L和6.2~8.0 mmol/L,将患者分为A组（55例）和B组（50例）。结果两组间终点血糖水平和日均胰岛素用量均存在显著差异,分别为5.3 mmol/L vs 7.1 mmol/L,P〈0.001和66.66 u/d vs 49.57 u/d,Ρ〈0.001,低血糖发生率12.7%和2.0%P=0.039,但是两组间死亡率和并发症发生率差异无统计学意义。结论在危重高血糖患者,将血糖降至接近正常,其死亡率和并发症发生率与正常血糖组相似,但减少了低血糖的发生率。Objective To observe the outcomes of the patients who had stress hyperglycemia at admission,and whose blood glu- cose levels were lowered to normal or near normal with insulin in ICU. Methods We prospectively analyzed patients whose admis- sion blood glucose was over 8.0mmol/L, but without history of diabetes. Of total 105 patients were classified according to their goal blood glucose： A group, 4.4-6.1 retool/L（55） ; B group 50 was 6.2-8.0 mmol/L. Results The final blood glucose and average daily dosage of insulin was 5.3mmol/L vs 7. lmmol/L （P〈0. 001）and 66.66u/d vs 49.57 u/d （P〈0. 001） ,respectively. Hypogly- cemia was 12.7% vs 2.0% （P=0. 039）. ICU morbidity and mortality were not different significantly. Conclusion Intensive insulin therapy to lower blood glucose to 6. lmmol/L and near it will obtain similar clinical outcomes in critical patients with stress hyperglycemia. The group whose blood glucose is slight above 6. lmmol/L has less hypoglycemia.

关 键 词：强化胰岛素治疗 危重病 应激性高血糖 

分 类 号：R977.15[医药卫生—药品] R459.7[医药卫生—药学]