强化胰岛素治疗老年脓毒症114例临床分析

Intensive insulin therapy for elderly patients with sepsis:report of 114 cases

目的探讨强化胰岛素治疗老年脓毒症患者的临床疗效。方法114例发生脓毒症的老年(>60岁)患者随机分为强化胰岛素治疗组(研究组)59例,常规胰岛素治疗组(对照组)55例。血糖控制目标值:研究组为4.4～8.3mmol/L,对照组为10～11.1mmol/L,两组其余临床治疗均相同。监测血清C反应蛋白水平变化、抗生素应用时间、院内新发感染发生率、血管活性药物应用量、需要血液净化治疗的急性肾衰竭的发生率和28d生存率等指标。结果与对照组比较,研究组老年脓毒症患者的C反应蛋白水平、抗生素应用时间、院内新发感染发生率、血管活性药物应用量、需要血液净化治疗的急性肾衰竭的发生率显著降低,28d生存率提高,且差异有统计学意义。治疗组低血糖发生例数多于对照组。结论对于老年脓毒症患者,早期强化胰岛素治疗能更加及时有效地控制血糖,并改善临床疗效。

Objective To observe the clinical effects of intensive insulin therapy in elderly patients with sepsis. Methods A total of 114 patients （60 years） with sepsis were randomly divided into two groups,intensive insulin therapy group （n=59） and routine insulin therapy group （n=55）. The blood glucose was controlled within 4.4-8.3 mmol/L in intensive insulin group,and 10.0-11.1 mmol/L in routine insulin therapy group. Other therapies were identical in two groups. The serum C-reactive protein （CRP） level,duration for antibiotic usage,hospital-acquired infection rate,amount of vasopressors used,incidence of acute renal failure requiring blood purification,28-day survival rate were recorded. Results In intensive insulin therapy group,the serum CRP level,duration for antibiotic usage,hospital-acquired infection rate,amount of vasopressors used,and incidence of acute renal failure requiring blood purification were significantly reduced,and 28-day survival rate was significantly elevated,compared with routine insulin therapy group. Conclusion For elderly patients with sepsis,early intensive insulin therapy can control blood glucose more effectively and timely,and can improve the clinical therapeutic effects.