强化胰岛素治疗在老年重症急性胰腺炎患者中的临床作用

Clinical effects of intensive insulin therapy on severe acute pancreatitis in elderly patients

目的探讨强化胰岛素治疗控制血糖对于老年重症急性胰腺炎患者的临床意义。方法将40例>70岁老年重症急性胰腺炎患者分成强化胰岛素治疗组(I组)和非强化治疗组(N组),I组通过胰岛素静脉泵将空腹血糖(FBG)控制在4.4～6.1 mmol/L。N组当FBG>11.1 mmol/L时使用胰岛素治疗并将FBG控制在10.0～11.1 mmol/L。观察2组血糖变化情况、APACHEⅡ评分变化情况、并发症发生情况、住院时间。结果(1)I组在治疗后1 d血糖降至正常水平,且较入院时明显下降,N组在治疗后3 d才较入院时明显下降;(2)I组在治疗后3 d APACHEⅡ评分较入院时明显下降,N组APACHEⅡ评分在治疗后7 d较入院时明显下降(P均<0.05);(3)I组住院时间明显短于N组(P<0.01);(4)I组与N组总体并发症发生情况无明显差异,但I组手术病人的并发症发生显著低于对照组(P<0.05)。结论强化胰岛素治疗控制血糖对于改善老年重症急性胰腺炎患者的预后具有积极意义,并可减少手术患者并发症的发生。

Objective To study the clinical effects of the intensive insulin therapy on acute severe pancreatitis in elderly patients. Methods Forty patients aged over 70 were divided into two groups ： group I（ maintenance of blood glucose at a level between 4. 4 and 6. 1 mmol/L） and group N（ maintenance of blood glucose at a level between 10. 0 and 11.1 mmol/L）. Insulin was infused by micro-injection pump. The changes of blood glucose, APACHE Ⅱ score, complications, average length of stay in hospital and prognosis were observed. Results （ 1 ） The average blood glucose level of group I was significantly decreased after 1 st day treatment, group N＇s was significantly decreased after 3rd day treatment. （2） The average APACHE Ⅱ score of group I was significantly decreased after 3rd day treatment, group N＇s was significantly de- creased after 7th day treatment（ P 〈 0.05 ）. （ 3 ） The average length of stay in hospital of group I was significantly shorter than that of Group N（ P 〈 0. 01 ）. （4）The operated patients＇ complications of Group I were significantly decreased （P 〈 0. 05 ）. Conclusions Intensive insulin therapy contributes to the outcome of the elderly patients with severe acute pancreatitis.