胰岛素强化治疗对急诊重症监护病房危重病患者预后的影响

The Clinical Significance of Intensive Insulin Therapy to Criticall Illness Patients in ICU

目的探讨急诊重症监护病房（ICU）危重病患者胰岛素强化治疗与预后的关系。方法选择入急诊ICU监护前无糖尿病病史且存在高血糖的危重病患者126例,收住ICU时血糖为（15.3±6.7）mmol/L。将患者随机分为3组,每组42例,均给予胰岛素强化治疗。A组血糖控制在4.4-6.1 mmol/L;B组血糖控制在6.1-8.3 mmol/L;C组血糖控制在8.3-11.1 mmol/L。观察3组患者治疗后的抗生素使用时间、入住ICU时间、入住ICU最后1 d的A-PACHE II评分、院内感染发生率、多脏器功能衰竭（MOF）发生率及病死率等参数。结果 A组患者治疗后抗生素使用时间、入住ICU时间、院内感染发生率、MOF发生率及病死率均显著低于C组,差异有统计学意义（P〈0.05）。B组患者入住ICU时间及院内感染发生率显著高于A组,差异有统计学意义（P〈0.01）。B组患者MOF发生率及病死率均显著低于C组,差异有统计学意义（P〈0.05）。结论对于急诊ICU危重病患者给予胰岛素强化治疗,将血糖控制在4.4-6.1 mmol/L可改善预后,降低并发症发生率及病死率。

Objective To evaluate the clinical significance of intensive insulin therapy to critically ill patients in the ICU.Methods 126 patients without diabetes history before onset had a plasma glucose level of（15.3±6.7）mmol/L on admission.They were randomly divided into three groups,with each group 42 pateints.Group A had plasma glucose 4.4～6.1 mmol/L,group B 6.1～8.3 mmol/L and group C 8.3～11.1 mmol/L.Then observe the time of apply antibiotic,the time of into ICU,APACHE II score at length,endogenous infection rate,multiple organ failure rate and fatality rate.Results In terms of the time of apply antibiotic,the time of into ICU,APACHE II score at length,multiple organ failure rate and fatality rate,group A were significantly lower than group C（P〈0.05）.In terms of the time of apply antibiotic,the time of into ICU,group A were significantly lower than group B（P〈0.05）.In terms of the multiple organ failure rate and fatality rate,group B were significantly lower than group C（P〈0.05）.Conclusion By Intensive insulin therapy,controlling plasma glucose at 4.4～6.1 mmol/L in critically ill patients from ICU is advantageous with improved prognosis and reduced complication rate and fatality rate.