强化胰岛素治疗重型颅脑损伤伴高血糖的疗效观察  

Clinical Efficacy of Intensive Insulin Therapy for Severe Traumatic Craniocerebral Injury with Hyperglycemia

作　　者：胡学安[1] 胡世颉[1] 李兵[1] 邹西峰[1] 张磊[1] 曹宝萍[1] 王冰[1] 费舟[1] 

机构地区：[1]第四军医大学西京医院神经外科,西安710032

出　　处：《神经损伤与功能重建》2015年第1期23-25,共3页Neural Injury and Functional Reconstruction

基　　金：国家自然科学基金青年科学基金(No.81101710)

摘　　要：目的：观察对重型颅脑损伤伴高血糖的患者进行强化胰岛素治疗的临床疗效。方法：重型颅脑损伤患者112例随机分为强化组和对照组各56例,强化组给予强化胰岛素治疗,控制血糖为4.4～6.1 mmol/L;对照组给予常规胰岛素治疗,控制血糖为6.1～10.1 mmol/L。严密观察患者住院期间的生命体征,每隔1～2 h测试血糖,随访6个月记录格拉斯哥预后评分（GOS）。结果：与对照组比较,强化组患者的胰岛素使用天数、院内感染率、ICU死亡率、6个月内恢复良好率较低（P〈0.05）,低血糖发生率、6个月内死亡率较高（P〈0.05）。结论：强化胰岛素治疗重型颅脑损伤伴高血糖在降低近期死亡率和感染率方面较常规胰岛素治疗有明显优势,但更易导致低血糖发生,在改善远期神经功能上无明显优势。Objective： To observe the clinical efficacy of intensive insulin therapy for the patients with severe traumatic craniocerebral injury. Methods： One hundred and twelve patients with severe traumatic craniocerebral injury were randomly divided into intensive group（56 cases） and control group（56 cases）. The intensive group were given intensive insulin therapy, controlling the blood glucose between 4.4～6.1 mmol/L, while the control group were given conventional insulin therapy, controlling the blood glucose between 6.1～10.1 mmol/L. The effect was assessed with the vital signs of patients during hospitalization, blood sugar was tested every 1～2 h, the Glasgow outcome scale（GOS） score was evaluated at 6 months after injury. Results： Compared with the control group, the number of insulin administration days, nosocomial infection, ICU mortality, good recovery rate within 6months of the intensive group decreased significantly（P〈0. 05）; the hypoglycemia incidence, mortality rate within6 months increased significantly（P〈0.05）. Conclusion： Intensive insulin treatment is more effective in reducing mortality and infection rates than conventional method. However, it is more likely to cause hypoglycemia and shows no advantage in improving the long-term neurological function compared with normal treatment.

关 键 词：重型颅脑损伤 应激性高血糖 强化胰岛素治疗 

分 类 号：R741[医药卫生—神经病学与精神病学] R741.05[医药卫生—临床医学]