强化胰岛素治疗在内科综合性ICU中的疗效分析研究

Clincal Application of Intensive Insulin Therapy in Medical ICU

目的研究强化胰岛素治疗在内科综合性ICU的临床疗效.方法选择至少在内科综合性ICU病房监护5 d以上,且既往无糖尿病史的危重病患者168例,收住ICU时血糖水平(13.8±5.5)mmol/L,随机分为3组(n=56),第1、2组给予强化胰岛素治疗,使血糖控制在4.4～6.1 mmol/L、4.4～8.3 mmol/L;第3组当血糖大于11.1 mmol/L时予常规胰岛素治疗,分别使血糖控制在8.3～11.1 mmol/L;观察3组患者使用抗生素天数、机械通气天数、急性肾功能衰竭发生率、院内感染发生率、应激性溃疡发生率、低血糖发生率、多器官功能衰竭发生率、在ICU最后1 d急性生理学与慢性健康状况评分(APEACHⅡ)、住ICU天数及病死率(28 d)等参数.结果第1、2组在使用抗生素天数,机械通气天数,急性肾功能衰竭发生率,院内感染发生率,应激性溃疡发生率,多器官功能衰竭发生率,在ICU最后1 d急性生理学与慢性健康状况评分(APACHE I)I,住ICU天数及病死率(28 d)等参数均明显低于第3组(P<0.05).且第2组低血糖发生率低于第1组(P<0.05).结论对于内科综合性ICU的危重患者强化胰岛素治疗将血糖水平控制在4.4～8.3 mmol/L,可改善危重病患者的病情,降低病死率,且减少低血糖的发生.

Objective To study the effect of intensive insulin therapy in medical ICU.Methods One hundred sixty-eight critically ill patients without diabetes were selected in the study.These Patients stayed in intensive care unit（ICU）for at least five days,and the blood glucose levels were（13.8±5.5 mmol/L）when they entered ICU.The patients were randomly divided into three groups（n=56）.Patients in the first and the second group received intensive insulin therapy,whose blood glucose levels were controlled in 4.4～6.1 mmol/L and 4.4～8.3 mmol/L respectively.While patients in the third group received routine insulin therapy,whose blood glucose levels were controlled in 8.3～11.1 mmol/L.Some parameters as follows were observed：the days of using antibiotics,the days of mechanical ventilation,the incidence of nosocomial infection,the incidence of acute renal failure,the incidence of stress ulcer,the morbility of hypoglycemia,the morbility of multiple organ failure（MOF）,Acute physiology and Chronic Health Evaluation（APACHEII）score of the last day in ICU,total days in ICU and the mortality.Results Parameters in the first and second such as the days of using antibiotics,the days of mechanical ventilation,the incidence of nosocomial infection,the incidence of acute renal failure,the incidence of stress ulcer,the morbility of multiple organ failure（MOF）,Acute physiology and Chronic Health Evaluation（APACHEII）score of the last day in ICU,total days in ICU and the mortality were lower than those in the third group（P0.05）.The incidence of low blood glucose in the second group was lower than that in the first group（P0.05）.Conclusion In intensive insulin therapy for medical ICU patients,keePing the blood glucose levels in 4.4～8.3 mmol/L can improve the patients＇condition,reduces the mortality and the incidence of hypoglycaemia.