短期胰岛素强化治疗在重型颅脑损伤应激性高血糖患者中的应用

Therapeutic effect of short term intensive insulin on stress hyperglycemia in patients with severe traumatic craniocerebral injury

目的探讨短期胰岛素强化治疗对重型颅脑损伤应激性高血糖患者的临床疗效及预后的影响。方法选择入住ICU既往无糖尿病史的重型颅脑损伤患者136例,随机分为治疗组和对照组,每组68例,治疗组给予7d强化胰岛素治疗,随后给予常规血糖控制,对照组始终给予常规血糖控制。强化胰岛素治疗控制血糖在4.4～8.3mmol/L,常规血糖控制在4.4～11.1mmol/L。结果治疗组ICU住院时间、机械通气天数、ICU最后1 d APACHE Ⅱ评分、院内感染率、病死率均低于对照组,差异有统计学意义(P<0.05);治疗组患者恢复良好率和病死率优于对照组(P<0.05)。结论短期胰岛素强化治疗能有效改善重症颅脑损伤患者的预后。

Objective To investigate the therapeutic effect of short term intensive insulin on stress hyperglycemia in patients with severe traumatic craniocerebral injury and to observe patients＇ prognosis.Methods One hundred and thirty six patients with severe traumatic craniocerebral injury without diabetic history who were selectively admitted into ICU were randomly divided into treatment group and control group,with 68 patients in each group.The patients in treatment group were treated by intensive insulin for 7 days,during the periods the patient＇s blood glucose levels were kept at 4.4～8.3mmol/L,then they were given conventional insulin treatment,with keeping the blood glucose levels at 4.4～11.1mmol/L,however,the patients in control group were treated by conventional insulin all the time,with keeping the blood glucose levels at 4.4～11.1mmol/L.Results The length of staying in ICU,days of mechanical ventilation,APACHE Ⅱ score at the last day in ICU,incidence of nosocomial infections and mortality in treatment group were significantly lower than those in control group（P0.05）.The recovery rate in treatment group was superior to that in control group（P0.05）.Conclusion Short term intensive insulin therapy can effectively improve the prognosis of patients with severe traumatic craniocerebral injury.