胰岛素强化治疗老年患者手术后应激性高血糖的效果观察

Curative effect of intensive insulin therapy in critical old patients with stress hyperglycemia

目的观察早期胰岛素强化治疗大手术后应激性高血糖患者的临床疗效。方法将监护室收治的大手术后发生应激性高血糖的老年危重患者56例，随机分为胰岛素强化治疗组与胰岛素常规治疗组，每组各28例。监测治疗前后血清C反应蛋白水平、泵入胰岛素天数、伤口愈合情况、住ICU天数、院内感染发生率、病死率等指标及发生低血糖反应和低钾血症等并发症的情况。结果强化组患者的C反应蛋白下降水平、使用胰岛素天数、住ICU天数、院内感染发生率、死亡率明显降低，与常规组比较差异有统计学意义（P〈0．05），伤口愈合率高于常规组（P〈0．05）；强化组低血糖发生率明显增高（P〈0．05），低血钾发生率无统计学意义。结论老年危重病术后发生应激性高血糖患者，早期胰岛素强化治疗能更有效、更及时地控制血糖，显著改善临床疗效。但应注意加强对低血糖反应和低钾血症的预防和护理。

Objective To observe the clinical curative effect of early intensive insulin therapy for critical old patients with stress hyperglycemia. Methods Fifty-six （ 〉 60 years） patients in critical conditions with stress hyperglycemia were divided into two groups randomly, the intensive insalin-therapy （IIT） group （ n = 28） and traditional insulin-therapy （TIT） group （ n = 28 ）. The serum C -reactive protein （CRP） level, the time of the usage of insulin-infusion, the days in the ICU, the incidence of infection in hospital, mortality and the complications of hypoglycemia and hypokalemia were recorded. Results In IIT group, the serum CRP level, the time of usage of insulin, the days in the ICU, the incidence of infection in hospital and mortality were significantly lower than that in TIT group. （P 〈 0. 05 ）, but the wound healing rate was elevated obviously. As to complications, the incidence of hypoglycemia and hypokalemia was higher in IIT group than that in TIT group, even though there was no statistical significance on incidences of hypokalemia. Conclusions For critical old patients with stress hyperglycemia, early intensive insulin therapy can control blood glucose more effectively and promptly and improve the clinical curative effect. But the targeted nursing care for hypoglycemia and hypokalemia should be reinforced for the patients with intensive insulin-therapy.