小剂量生长抑素在危重病人强化胰岛素治疗中的应用研究

Application of small dosage somatostatin to intense insulin therapy of critical patients

目的探讨小剂量生长抑素用于危重病人血糖控制的临床效果。方法icu危重患者50例,随机分为两组：A组（胰岛素组）,B组（胰岛素＋生长抑素组）,每组25例,控制血糖目标为4.4-8.0 mmol.L^-1,A组单用常规胰岛素,B组同时给予生长抑素（奥曲肽）0.1 mg皮下注射,每8 h一次,观察两组病人首次达到目标范围所需要的时间,5 d内血糖达标的小时数,平均每天胰岛素的用量,每天血糖的波动幅度（血糖最高值—血糖最低值）,治疗期间低血糖和低血钾的发生频率,治疗后炎症因子水平及预后指标等指标。结果B组（胰岛素＋生长抑素组）血糖控制所需要的胰岛素明显比A组少,而且B组的血糖波动更少,达标时间更长。出现低血糖,低血钾的病人数和出现次数均比A组少,而且治疗后血c反应蛋白（CRP）,肿瘤坏死因子（TNF）等炎症指标较A组下降,但APACHEⅢ评分,两周内死亡例数,院内感染发生率等预后指标无明显差异。结论危重病人强化胰岛素治疗血糖控制目标以4.4-8.0 mmol.L^-1为宜,小剂量生长抑素配合常规胰岛素在危重病人血糖控制中的应用有利于减少血糖波动和胰岛素用量,减少并发症的发生,降低炎症因子水平,但尚无可以改善预后的证据。

Aim To investigate the clinic effect of small dosage somatostatin on blood sugar control of critical patients.Methods 50 critical patients in ICU were randomly divided into two groups： group A（insulin group）,group B（insulin and somatostatin group）,25 paitents per group.Blood sugar control target was 4.4~8.0 mmol·L-1.Group A only used regular insulin,group B hypodermic injected somatostatin（octreotide）0.1mg per 8 hours.We recorded time when rearching blood sugar target for the first time,hours of rearching blood sugar target with in five days,average dosage of insulin every day,the wave range of blood sugar（the highest level-the lowest level）every day,the frequency of hypoglycemia and hypokalemia during theraphy,the inflammation factor levels and prognosis indexes after treatment.Results Group B（insulin and somatostatin group） had smaller dosage of insulin,smaller wave range of blood sugar,longer reaching target time,smaller frequency of hypoglycemia and hypokalemia than group A（P〈0.05）.The blood levels of inflammation factors such as C react protein（CRP）,tumor necrosis factor（TNF）of group B were lower than group A（P〈0.05）,but the prognosis indexes such as APACHE Ⅲ grade,death rate in two weeks and rate of hospital-acquired infection were similar in two groups（P〉0.05）.Conclusions Blood sugar control target 4.4~8.0 mmol·L-1 was suitable for intense insulin therapy of critical patients.Small dosage of somatostatin assisting regular insulin in blood sugar control of critical patients could reduce wave range of blood sugar,dosage of insulin,side effects,and levels of inflammation factors,but no evidences were found to prove it can reform the prognosis of these paitents.