目标导向性血糖控制策略在急性重症胰腺炎中的应用

The application of goal-oriented strategy of glycemic control in severe acute pancreatitis

目的探讨目标导向性血糖控制策略在急性重症胰腺炎应用的可行性和安全性。方法将2013年5月-2014年4月湖南省人民医院SICU 96例急性重症胰腺炎患者随机分2组：A组应用目标导向性血糖控制策略,B组应用传统方法血糖控制管理,两组血糖控制目标值均为7.8-10.0 mmol/L,比较两组患者血糖控制有效性、安全性及预后指标。结果两组患者平均血糖均在目标范围,两组患者达到目标血糖时间,高血糖指数、低血糖发生频率、感染发生率比较,差异有统计学意义（P〈0.05）。两组患者血糖监测次数、胰岛素治疗天数、每日胰岛素量比较相近,差异无统计学意义（P〉0.05）。两组患者中/重度营养不良发生率、MODS发生率、上呼吸机天数、血液净化例数、平均监护时数、28天死亡例数比较,差异无统计学意义（P〉0.05）。结论目标导向性血糖控制策略可降低急性重症胰腺炎患者低血糖风险、更快的达到血糖控制目标,更安全有效,可降低SAP患者感染发生率。

【Objective】To explore the feasibility and safety of glycemic control goal-oriented strategy application in the acute pancreatitis.【Methods】From May 2013 to April 2014 at SICU of Hunan Provincial People＇s Hospital,96 cases of acute pancreatitis were randomly divided into two groups： the goal-oriented blood glucose control strategy was used in group A, the traditional blood glucose control method was used in group B. The value of blood sugar goal control for two groups was 7.8 -10.0 mmol/L, glycemic control efficacy, safety, and prognostic indicators were compared between two groups. 【Results】An average blood glucose value was controlled under the goal range for two groups. The target blood sugar time, high glycemic index, the frequency of hypoglycemia and the incidence of infection were not significantly different between two groups（P〉0.05）. The frequency of monitoring blood glucose,the day number of insulin therapy and the daily amount of insulin were relatively similar without statistical significance（P〈0.05）. The moderate/severe malnutrition rates, MODS incidence, the number of days on the ventilator, number of cases with blood purification, the average care hours, died cases in 28 days were not statistically significant between two groups（P〉0.05）. 【Conclusion】 Goal-oriented strategy can reduce risk of hypoglycemia for severe acute pancreatitis and achieve blood sugar control goal faster, safer and more effective, can reduce the incidence of infection in patients with SAP.