分层血糖控制对肺部感染并发呼吸衰竭急危重患者预后的影响  

Influence of different blood glucose control on prognosis of critically ill patients with lung infection and respiratory failure

作　　者：冯宪真[1] 赵瑾[1] 孙科远[1] 杨伟[1] 周军[1] 冯丽丽[1] 张俊杰[1] 赵文穗[1] 

机构地区：[1]上海市长宁区中心医院急诊科,上海200336

出　　处：《实用临床医药杂志》2014年第5期38-40,共3页Journal of Clinical Medicine in Practice

摘　　要：目的观察胰岛素泵强化血糖控制对肺部感染并发呼吸衰竭急危重病人预后的影响。方法选择入住急诊重症监护室(EICU)的ApacheⅡ评分>15分、同时合并高血糖(随机血糖>11.1 mmol/L)的内科危重病人200例,随机分为强化胰岛素治疗(IIT)组和常规治疗(CIT)组(胰岛素泵血糖控制),其中IIT组和CIT组各包含肺部感染引起的呼吸衰竭31例和33例,观察2组患者呼吸机、抗生素使用天数,近期死亡率(28 d内)、入院3 d及7 d后的APACHEⅡ评分、低血糖发生率,院内感染发生率、住院天数、住院费用等指标。结果 IIT和CIT 2组年龄、性别构成比、血氧饱和度、氧分压、二氧化碳分压、pH值、血压、呼吸衰竭类型、血糖、炎症指标、电解质、心功能、肝肾功能、空腹C肽、HbAlc、APACHEⅡ评分等指标比较差异无统计学意义(P>0.05),具有可比性。IIT组院内感染发生率、3 d及7 d后的APACHEⅡ评分、死亡率、住院天数、呼吸机、抗生素使用天数、住院费用低于CIT组(P<0.05);IIT组低血糖发生次数明显高于CIT组(P<0.01),但2组严重低血糖发生次数差异无统计学意义(P>0.05)。结论严格强化血糖控制对肺部感染并发呼吸衰竭急危重患者可能带来较多益处,并降低近期死亡率。Objective To explore the influence of intensive glycemic control by insulin pump on prognosis of critically ill patients with lung infection and respiratory failure. Methods In the emergency intensive care unit （EICU）, 200 critically ill patients with hyperglycemia （A- PACHE Ⅱ score 〉15 , random blood glucose 〉 11.1 mmol/L） were collected and randomly divided into the intensive insulin therapy （IIT） group and the convention insulin therapy（CIT） group（use insulin pump to control blood glucose）. IIT group and CIT group included 31 cases and 33 cases of pulmonary infection and respiratory failure. Ventilator and antibiotic use days, shortterm mortality （within 28 days）, rate of hypoglycemia, nosocomial infection, hospital stay and hospital costs were observed and compared between two groups. Results There was no significant differences between two groups in aspects of age, sex ratio, oxygen saturation, pressure of oxygen, pressure of Carbon dioxide, pH, blood pressure, respiratory failure type, blood glucose, electrolytes, inflammation, heart function, liver and kidney function, fasting C peptide, HbAlc and APACHEⅡ score（P〉0.05）. APACHE II score at the time of 3 days and 7 days after admission, nosocomial infection, short - term mortality hospital day and hospital costs （ P 〈 0.05） in the IIT group were significantly lower and shorter than the CIT group. The hypoglycemia incidence rate of the IIT group was significantly higher than that of the CIT group （P 〈 0.01 ）. Result of serious hypoglycemia showed no significant difference between the two groups . Conclusion Strict intensive glucose control on pulmonary infection and respiratory failure may bring more benefits for acute and critically ill patients, and it can reduce the short - term mortality rate.

关 键 词：急危重病 高血糖症 胰岛素强化治疗 呼吸衰竭 

分 类 号：R441.8[医药卫生—诊断学]