危重症病人应激性高血糖短期胰岛素强化治疗的临床护理

Clinical nursing of short course intensive insulin therapy on stress hyperglycemia in critically ill patients

目的:探讨短期胰岛素强化治疗对危重病人预后的影响,并分析相关护理问题。方法:选择入住ICU、既往无糖尿病史的危重病人108例,随机分为治疗组和对照组各54例。治疗组给予7 d的短期强化胰岛素治疗,随后给予常规的血糖控制;对照组则一直给予常规的血糖控制。强化胰岛素治疗控制血糖在4.4～8.3 mmol/L,常规血糖控制在4.4～11.1 mmol/L。结果:治疗组ICU住院时间、机械通气天数、院内感染发生率、多器官功能障碍综合征(MODS)发生率及病死率均明显低于对照组(P<0.05),两组低血糖的发生率差异比较无统计学意义(P>0.05)。结论:短期胰岛素强化治疗能有效控制重症病人的应激性高血糖,改善预后,实施过程中要做好病人血糖动态监测工作,减少低血糖的发生率。

To investigate the effect of short course intensive insulin therapy on stress hyperglycemia in critically ill patients. Methods ： One hun- dred and eight patients without diabetes in ICU were randomly divided into treatment group and control group 54 patients in each group. Treatment group was received intensive insulin therapy for 7 days,During the periods the blood glucose was maintained between 4.4 -8.3 mmol/L, then they were given conventional insulin treatment maintaining the blood glucose between 4.4 - 11.1 mmol/L, conventional insulin treatment was administrated in control group to maintain the blood glucose between 4.4 - 11.1 mmol/L. Results ：The days in ICU, the days of mechanical ventilation, the incidence of nosecomial infections,the rates of MODS and mortality were silgtificanfly lower in treatment group than in contrel group （ P 〈0.05 ）. The morbidity of hypoglycemia were no significant difference between the two groups（ P 〉 0.05）. Conclusion：In critically ill patients, short course intensive insulin therapy can effectively control the stress hyperglycemia, improve the prognosis and reduces the morbidity of hypoglycemia.