强化胰岛素治疗策略对严重脓毒症患者预后的影响  

The clinical study of intensiye insulin therapy of severe sepsis

作　　者：叶振海[1] 桂敬敏 尤雷明 张烜舜 卢杰[1] 

机构地区：[1]安徽省芜湖市第一人民医院ICU,241000

出　　处：《中国医药》2011年第10期1210-1211,共2页China Medicine

摘　　要：目的研究强化胰岛素治疗方案对严重脓毒症呼吸衰竭合并高血糖患者预后和并发症的影响。方法选择严重脓毒症呼吸衰竭并发高血糖症且住院超过3d的患者142例，完全随机分为强化胰岛素治疗组（将血糖严格控制在4．4～6．1mmol／L）和常规治疗组（将血糖控制在10．0～11．1mmol／L）。观察比较2组ICU病死率、总住院病死率、ICU住院时间和总住院时间。结果与常规治疗组比较，强化胰岛素治疗组的ICU住院天数、总住院天数和呼吸机治疗时间均明显缩短[（12±3）d比（15±4）d；（19±6）d比（24±7）d；（10±2）d比（14±3）d；P〈0．01]，ICU病死率和总住院病死率降低[22．5％（16／71）比42．3％（30／71）；36．6％（26／71）比54．9％（39／71）；P〈0．05]，继发性肾损害减少[8．5％（6／71）比19．7％（14／71）；P〈0．05]。结论治疗严重脓毒症合并高血糖患者时，不应考虑其既往是否有糖尿病史，而是应该应用强化胰岛素治疗方案将血糖降至正常范围。Objective To investigate the effect of intensive insulin therapy on severe sepsis. Methods In a prospective,randomized controlled study, adult patients who were considered to need intensive care for at least three days were enrolled. On admission, one hundred and forty-two severe sepsis patients with hyperglycemia were randomly dividided into intensive insulin therapy group （ maintenance of blood glucose at a level between 4.4 and 6.1 mmol/L） or conventional therapy group （ infusion tapered when the level of glucose at a level between 10.0 and 11. 1 mmol/L）, Mortality in the ICU, mortality in the hospital, days weaning from mechanical ventilation, days in the ICU and in the hospital, new kidney injury and new hepatic injury during intensive care were observed. Results The days in the ICU （12 ±3 days vs 15 ±4 days） ,in the hospital （19 ±6 days vs 24 ±7 days） and the days weaning from mechanical ventilation （10 ± 2 days vs 14 ± 3 days） in intensive insulin therapy group were significantly reduced than those in the conventional therapy group （P 〈0.01 ）. The mortality in the ICU （22.5% in the intensive insulin therapy group vs 42.3% in the conventional therapy group, P 〈 0.05 ） and in the hospital （36.6% vs 54.9%, P 〈 0.05） were also significantly reduced, Morever,morbidity was significantly reduced by the prevention of newly acquired kidney injury （8.5% vs 19.7% , P 〈 0.05）. Conclusion Glucose levels in severe sepsis patients should be controlled through implementation of intensive insulin therapy to achieve normoglycemia, regardless of a history of diabetes.

关 键 词：脓毒症 胰岛素 血糖 病死率 并发症 

分 类 号：R515.3[医药卫生—内科学]