摘要
目的探讨早期应用胰岛素泵控制重型颅脑损伤后高血糖与患者预后的关系。方法80例格拉斯哥昏迷量表(GCS)评分≤8分的重型颅脑损伤后高血糖患者,根据入院时GCS评分分为G1组(GCS评分3~5分,39例),G2组(GCS评分6~8分,41例);根据高血糖控制方法的不同,按随机数字表法分为胰岛素皮下持续输注(CSII)治疗组40例,多次皮下胰岛素注射(MSII)治疗组40例,均控制血糖目标在相同范围。记录两组治疗后达到目标血糖所需时间、胰岛素用量、低血糖反应发生情况及治疗2个月的格拉斯哥预后量表(GOS)评分。结果G1组入院随机血糖为(12.0±2.4)mmol/L,G2组人院随机血糖为(8.6±1.5)mmol/L,差异有统计学意义(P〈0.05)。CSII治疗组与MSII治疗组比较,血糖达标时间明显缩短[(3.35±0.98)d比(6.20±1.02)d]、胰岛素用量明显减少[(39.3±7.6)U/d比(52.6±10.2)UN]、低血糖发生率亦明显降低[5.0%(2/40)比15.0%(6/40)],差异均有统计学意义(P〈0.05)。80例患者中预后良好42例,血糖水平为(7.1±1.8)mmol/L,预后较差26例,血糖水平为(9.1±2.2)mmol/L,死亡12例,血糖水平为(11.9±2.5)mmol/L,差异有统计学意义(P〈0.05)。结论早期胰岛素泵治疗能够快速平稳控制重型颅脑损伤后高血糖,而且能够明显改善重型颅脑损伤患者的预后。
Objective To explore the relationship between early use of insulin pump and the prognosis in patients with hyperglycemia after severe craniocerebral injury. Methods Eighty severe craniocerebral injury patients' Glasgow coma scale (GCS) scores and blood glucose were examined before therapy, and randomly divided into different groups: ( 1 ) GCS 3 - 5 scores was in group G1 (39 patients), GCS 6 -8 scores was in group G2 (41 patients). (2) Forty patients who accepted continue subcutaneous insulin injection (CSII) was in CSII treatment group, other patients who accepted multi subcutaneous insulin injection (MSII) was in MSII treatment group. The goal blood glucose was controlled in the same range. The time of getting goal blood glucose, daily insulin dosage, frequency of hypoglycemia, the Glasgow outcome scale (GOS) scores after treatment 2 months were recorded. Results The level of random blood glucose in group G1 was (12.0 ± 2.4) mmol/L, in group G2 was (8.6 ± 1.5 ) retool/L, there was significant difference (P 〈 0.05). In CSII treatment group, the time of getting goal blood glucose was shorter, the daily insulindosage was reduced and the incidence rate of hypoglycemia was lower than that in MSII treatment group [(3.35 ±0.98) d vs. (6.20 ± 1.02) d, (39.3±7.6) U/d vs. (52.6 ± 10.2) U/d,5.0% (2/40) vs. 15.0% (6/40) ] (P 〈 0.05). In 80 patients, 42 patients was better prognosis, 26 patients was bad prognosis and 12 patients was dead, the level of blood glucose was (7.1 ± 1.8), (9.1 ± 2.2), ( 11.9 ± 2.5 ) mmol/L respectively, there was significant difference(P 〈 0.05). Conclusion Early using insulin pump can rapidly and smoothly control hyperglycemia after severe craniocerebral injury, and can obviously ameliorate prognosis.
出处
《中国医师进修杂志》
2013年第8期28-30,共3页
Chinese Journal of Postgraduates of Medicine
关键词
胰岛素输注系统
高血糖症
颅脑损伤
预后
Insulin infusion systems
Hyperglycemia
Craniocerebral injury
Prognosis