危重颅脑疾病患者胰岛素强化治疗高血糖与预后相关性的研究

Relationship between hyperglycemia treated with intensive insulin therapy and prognosis in patients with critically craniocerebral disease

目的危重颅脑疾病患者高血糖程度是影响患者预后的重要因素,本研究旨在探讨强化胰岛素治疗与危重颅脑疾病患者的感染发生率及病死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为常规组(n=32)和胰岛素强化治疗组(n=32)。常规治疗是指当患者血糖≥11.1mmol/L时,控制其血糖水平<11.1mmol/L;强化治疗组则控制患者血糖接近正常水平(3.9～6.1mmol/L),直至患者转出ICU或死亡。分析两组病例预后指标之间的差异性。结果两组存活病例住ICU时间、机械通气时间方面比较差异有统计学意义。两组病例在肺部感染、尿路感染发生率、血培养阳性率、病死率方面差异有统计学意义。结论危重颅脑疾病患者应用胰岛素强化治疗,将血糖控制于正常范围有助于降低患者的感染发生率及病死率,改善预后。

Objective Stress hyperglycemia was common problem in the patients with critically craniocerebral disease, the presence of hyperglycemia associated with an increased risk of infection and mortality. It was necessary to investigate the relationship between intensive insulin therapy to maintain blood glucose 3.9 - 6.1 mmol/L and the prognosis of patients. Methods We performed a prospective, randomized, controlled study involved in the patients with critically craniocerebral disease. 64 patients were randomly assigned to treatment group or control group. Treatment group （32 cases） received intensive insulin therapy, the blood glucose levels were preserved 3.9 - 6. 1 mmol/L. The control group （ 32 cases） received routine insulin therapy, the blood glucose levels were maintained under 11.1 mmol/L. The hours in ICU, the time of mechanical ventilation, the incidence rate of infection, mortality were recorded. Results The hours in ICU, the time of mechanical ventilation, the incidence rate of infection, mortality were decreased significantly in the treatment group than those in the control group （ P 〈 0.05 ）. Conclusion Intensive insulin therapy might improve the effect and reduce the incidence rate of infection and mortality of patients with critically craniocerebral disease.