计算机程序化强化胰岛素治疗在术后危重病人中的应用

Intensive Insulin Therapy in Postoperative Intensive Care Unit Patients

应激性高血糖是ICU病人常见的临床现象．与危重病严重程度相关，并成为一独立因素影响病人的预后。因此．严格控制血糖水平已成为危重症综合治疗中的一项重要策略。 目的：建立一个便于掌握的血糖控制草案．使危重病人的血糖得到安全、有效的控制。 对象与方法：2299例术后入ICU时间24小时以上．年龄＞16岁的危重病人。分为草案前组（n=44．每位医生根据自身经验调节胰岛素泵入速度）、草案组（n=75．使用我科制定的强化胰岛素治疗方案调节胰岛素泵入速度）和程序组（n=110．使用我科制定的计算机程序化强化胰岛素治疗方案,调节胰岛素泵入速度），控制血糖目标80-110mg／dl。 结果：程序组的平均血糖，高血糖指数明显减少（P＜0．001），程序组的四间位间距．低血糖（〈60mg/dl和61-70mg／dl）发生率及每日平均血糖检测次数减少（P＜0．05）。 结论：通过计算机程序化管理的强化胰岛素治疗草案有助于严格血糖控制策略的安全．有效实施．并易于掌握．推广。

Stress hyperglycemia is common in ICU patients. It is related with the grade of critical illness and becomes an independent factor that affects the prognosis. Therefore, it is an important strategy to strictly control the blood glucose level in the critical ill patients. Objective： To set up an easy control graft solution to control the blood glucose level safely and efficiently. Subjects and Methods： 229 critical patients, elder than 16 years and staying in ICU more than 24 hours after operation, participated in the study and were divided into three groups. In the control group （n=44）, insulin federate was based on physician individual experience. In the routine group（n=75） ,insulin federate was based on intensive insulin treatment solution applied in our department. In the programmed group （n=110）, Insulin federate was based on programmed intensive insulin treatment solution applied in our department. The blood glucose level maintained between 80-110mg/dl. Results： Significantly decreases on average blood glucose and hyperglycemic index （P〈0.001） were found in program group. The incidence of hypoglycemia（〈60mg/dl I） and test frequency were decreased. Conclusion： The program of controled intensive insulin treatment graft solution is helpful to execute the strategy of strictly control glycemia and can easily be understood and used extensively.