胰岛素强化治疗危重创伤患者应激性高血糖的效果

Rediscovery the Effect of Intensive Insulin Therapy on Stress Hyperglycemia in Critical Trauma Patients

目的：对危重创伤应激性高血糖患者采用不同目标血糖控制水平的胰岛素治疗，探讨其有效性和安全性。方法将153例危重创伤患者随机分为强化胰岛素治疗（IIT）组、胰岛素优化治疗（NST）组和胰岛素常规治疗（CIT）组，各51例。3组血糖控制水平分别为4.0-6.1 mmol/L、6.2~8.3 mmol/L和9.9-11.1 mmol/L。比较3组患者每日胰岛素用量、低血糖发生率、终点血糖、出ICU时APACHEⅡ评分、机械通气时间、住ICU时间、并发症发生率及病死率等。结果 IIT组每日胰岛素用量（U/d：60.2±15.2）、低血糖发生率（15.7%）均高于NST组和CIT组，NST组每日胰岛素用量高于CIT组（U/d：54.4.±15.4 vs 49.4±16.1，P＜0.05），低血糖发生率与CIT组（7.8%vs 5.8%）差异无统计学意义。IIT组终点血糖（5.4±0.8）mmol/L低于NST组（7.6±0.7）mmol/L和CIT组（10.4±0.9）mmol/L，NST组低于CIT组（均P＜0.05）。NST组出ICU时APACHEⅡ评分（9.3±7.5）分、机械通气时间（12.9±18.6）h和住ICU时间（4.9±3.3）d均最短（均P＜0.05），IIT组与CIT组间差异均无统计学意义。3组并发症发生率和病死率差异均无统计学意义。结论胰岛素治疗危重创伤患者应激性高血糖，将目标血糖控制在6.2~8.3 mmol/L效果最佳。

Objective To investigate the effect and safety of intensive insulin therapy on patients who had stress hy-perglycemia induced by critical trauma, when different blood glucose was aimed in surgery intensive care unit （SICU）. Methods We retrospectively analyzed SICU patients who were admitted between 2010.1-2012.7 with admission blood glucose and 30 minutes blood glucose both over 11.1 mmol/L ,and without known history of diabetes. In total, 153 pa-tients were set into three groups according to their target blood glucose：intensive insulin therapy （IIT） group with target blood glucose of 4.0-6.1 mmol/L;NICE SUGAR （NST） group with target blood glucose of 6.2-8.3 mmol/L;conventional in-sulin therapy（CIT）group with target blood glucose of 9.9-11.1 mmol/L. Each group had 51 patients. To collect data from these three groups of patients,we compared daily insulin doses , hypoglycemia incidence, final blood glucose, APACHEⅡscores upon discharging from ICU, time of the ventilatory support, length of staying in ICU, morbidity and mortality rate. Results Comparing these three groups, daily insulin dosage and hypoglycemia incidence, were significantly lower in NST and CIT group than in IIT group. Daily insulin dosage was higher in NST group than in CIT group;no significant difference of hypoglycemia incidence was shown between NST group and CIT group. The final blood glucose was lowest in IIT group and highest in CIT group （P＆lt;0.05）. APACHE II score was 9.3±7.5 upon discharge from ICU in NST group. Ventilation time and duration of ICU admission both were shortest in NST group but show no significant difference between IIT and CIT group . No significant difference of complicate incidence and mortality rate was indicated among all three groups. Conclusion In patient with stress hyperglycemia induced by critical trauma,maintaining the patients’final blood glucose between 6.2-8.3 mmol/L can effectively control the stress hyperglycemia,improve prognosis and reduce the mortality of hypoglycemia.