强化胰岛素治疗对重型颅脑损伤患者预后的影响

Effect of intensive insulin therapy on prognosis of patients with severe head injury

目的：探讨强化胰胰岛素治疗对重型颅脑损伤患者预后的影响。方法：采用前瞻性研究方法，将重型颅脑损伤患者65例随机分为强化胰岛素治疗组（IIT）目标组（n=32例）及常规胰岛素治疗组（CIT）常规组（n=33例），目标组将24h平均血糖控制在4．4—6．1mmol／L，常规组将24h平均血糖控制在8．3～10.1mmol／L，观察指标用SPSS11．0进行统计分析。结果：两组患者使用胰岛素天数28dGCS评分及28d病死率差异无统计学意义（P〉0．05），两组患者平均血糖水平、单位时间胰岛素用量、血糖波动情况、低血糖发生率、每人每天血糖检测次数差异有统计学意义（P〈0．05）。结论：重型颅脑损伤患者强化胰岛素治疗不能降低病死率，增加了低血糖发生率，血糖控制在8．3—10．1mmol／L是适宜的。重型颅脑损伤及其他危得患者的强化胰岛素治疗需进一步研究。

Objective To discuss the effect of intensive insulin therapy on prognosis of patients with severe head injury. Method Total 65 patients with severe head injury were randomly divided into the intensive insulin treatment group （IIT group, n = 32） and the conven- tional insulin treatment group （ CIT group, n = 33 ）. The average glucose in 24 h was controlled between 4. 4 - 6. 1 mmol/L in IIT group and 8. 3 - 10. 1 mmol/L in CIT group. The observation indexes were statistically analyzed by SPSSll. 0. Results GCS scores and mortality rate after using insulin for 28 days in the two groups had no statistical difference （ P 〉 0. 05 ）. The average glucose level, insulin dosage in unit time, fluctuation of blood glucose, incidence of hypoglycemia and daffy detection time in the two groups had statistical difference （ P 〈 0. 05 ）. Conclusion The treatment of severe bead injury with intensive insulin can＇t decrease mortality rate, but increase the incidence of hypoglycemia. It is suitable to control blood glucose in the range of 8. 3 - 10. 1 mmol/L. The intensive insulin therapy should be further studied.