强化胰岛素控制血糖对重度颅脑外伤患者的疗效及分析

Control of blood glucose with intensive insulin therapy in patients with severe traumatic brain injury and the efficacy analysis

目的阐述强化胰岛素治疗控制血糖对NICU内重度颅脑外伤患者的感染率,NICU住院时间,神经功能预后及死亡率的影响。方法将202例入住NICU的重度颅脑外伤(TBI)患者前瞻性地随机分为两组,分别接受强化胰岛素治疗和传统的胰岛素治疗。结果随访6个月的总体死亡率,传统治疗组(Conventional Insulin Therapy,CIT)与强化治疗组(Intensive Insulin Therapy,IIT)相似(P=0.84)。接受CIT的患者感染率明显高于接受IIT组(P<0.05)。接受IIT的患者在NICU的住院时间少于CIT组(P<0.05)。研究期间的两组院内死亡率相似(P=0.90)。接受IIT的患者组随访6个月的GOS评分高于CIT组(P<0.05)。结论强化胰岛素治疗能有效改善重症颅脑外伤患者预后。

Objective To compare intensive insulin therapy to conventional glucose control in patients with severe traumatic brain injury evaluating infection rate,days in NICU,in-hospital mortality and long-term neurological outcome.Methods Total of 202 Patients with severe TBI （GCS score 3-8） after admission were randomized to receive conventional insulin therapy or intensive insulin therapy.Results The in-hospital mortality and the 6-month mortality were similar in both groups.The infection rate in patients who received conventional insulin therapy was significantly higher than that in patients who received intensive insulin therapy （P0.05）.The days stay in NICU in intensive insulin control group were shorter than that in conventional therapy group （P0.05）.The neurologic outcome according to Glasgow Outcome Score （GOS） at 6 months in the intensive insulin therapy group was better than that in the conventional therapy group （P0.05）.Conclusions Intensive insulin therapy can improve the prognosis of patients with severe traumatic brain injury.