危重颅脑疾病患者胰岛素强化治疗后营养状况及感染发生率的变化

Changes of nutrition status and the incidence of infection in hyperglycemia by intensive insulin therapy in the patients with critically cerebral disease

目的探讨强化胰岛素治疗控制患者血糖与危重颅脑疾病患者的营养状况、感染发生率等预后指标之间的相关性。方法采用前瞻、随机、对照临床试验,将64例危重颅脑疾病患者分别给予常规(n=32)和强化(n=32)胰岛素治疗。常规治疗是指当患者血糖≥11．1 mmol/L时,给予胰岛素治疗,控制血糖11．1 mmol/L以下即可；强化治疗是指患者血糖水平超过正常时,给予胰岛素强化治疗,控制血糖接近于正常水平(3．9～6．1 mmol/L),直至患者出院或死亡。分析两组病例在血白蛋白、前白蛋白、血尿素氮等营养指标及感染发生率之间的差异性。结果治疗7 d后,两组血浆白蛋白水平比较差异无统计学意义(P＞0．05),前白蛋白水平强化组高于常规组(P＜0．05),血尿素氮浓度强化组低于常规组(P＜0．05)。两组病例在肺部感染、尿路感染发生率及血培养阳性率方面比较差异有统计学意义(P＜0．05)。结论危重颅脑疾病患者采取胰岛素强化治疗高血糖,控制血糖于正常范围,可相应改善患者的营养状况,降低感染发生率,有助于改善预后。

Objective Stress hyperglycemia was common problem in the patients with critically cerebral disease,the presence of hyperglycemia was associated with the increased risk of the infection and mortality. It was necessary to investigate the relationship between intensive insulin therapy and changes of nutrition status and the incidence of infection in such patients. Methods We performed a prospective, randomized, controlled study . Sixty -four patients with critically cerebral disease were randomly divided into treatment group or control group. Treatment group（32 cases） received intensive insulin therapy , the blood glucose levels were preserved 3.9 - 6, 1 retool/ L. The control group（32 cases） received routine insulin therapy, the blood glucose levels were maintained under 11. lmmol/L. The changes of serum albumin, prealbumin ,urea nitrogen, the incidence of infection were measured during the study. Results Serum prealbumin increased significantly; Serum urea nitrogen, the incidence of infection were decreased significantly in the treatment group than those in the control group （P 〈0.05）, Conclusion Intensive insulin therapy might improve the nutrition status and reduce the incidence of infection in the patients with critically cerebral disease.