用胰岛素控制血糖于不同水平对危重症病人影响的临床研究

Impact of insulin therapy to control blood glucose on different levels on criticaly ill patients

目的：观察用胰岛素调控外科危重症病人的血糖水平，以探讨对病人并发症和预后的影响。方法：选择危重症病人934例，根据血糖控制水平的不同，分为严格控制血糖组（血糖控制在4，44—6．10mmol／L，n=478例）和对照组（目标血糖为6．10—8．32mmol／L，n=456）。比较两组病人常见的并发症、住院时间和ICU停留时间、住院费用以及ICU和住院期间的病死率等差异。结果：严格控制血糖组较对照组肾功能障碍和切口感染的发生率显著下降（P〈0．05）。严格控制血糖组的成人呼吸窘迫综合征（ARDS）、心律失常以及全身感染的发生率有下降趋势，但两组间无显著差异（P〉0．05）。两组病人住院时间和ICU滞留时间、住院费用、住院期间和ICU内的病死率均无显著差异。严格控制血糖组有47例（9．83％）病人并发了低血糖，对照组仅有7例（1．54％），两组间有显著性差异（P〈0．01）。结论：用胰岛素严格控制血糖于正常水平，能明显降低危重症病人并发症的发生，但同时也增加了低血糖的发生率。

Objective： To evaluate the effect of different levels of blood glucose control on prognosis of the patients in surgical intensive care unit （SICU）. Methods： 934 patients admitted to SICU were randomly divided into two groups. Blood glucose were controlled by insulin infusion. The blood glucose was maintained at the level of 4.44 -6.10 mmol/L in intensive insulin theraphy group （478 cases）. In control group （456 cases）, blood glucose was maintained at the level of 6.10 - 8.32 mmol/L. The outcome was evaluated by systemic and local complications, ICU and hospital mortality. Results： Compared with control group, acute renal dysfunction and incisional infection in intensive insulin theraphy group were significantly reduced （respectively ,5.23% vs 8.55% and 5.86% vs 9.87% ,P 〈0.05 ）. Although there was no significant difference between two groups, ARDS, arrhythmia and sepsis showed a descending tendency（respectively, 14.02% vs 17.76%, 12.97% vs 15.7% and 21.55% vs 25.22% ）. ICU and hospital mortality were not significantly different between two groups （ P 〉 0. 05 ）. Compared with control group, hypoglycemia in intensive insulin therapy group was very significantly increased （9.83% vs 1.54%, P 〈 0.01 ）. Conclusion ： The control of blood glucose in normal range with intensive insulin therapy can reduce complications of critically ill patients, but it was also increase the incidence of hypo- glycemia.