胰岛素强化治疗在呼吸机相关性肺炎并高血糖中的应用分析

Application analysis of insulin intensive treatment in ventilator-associated pneumonia and high blood glucose

目的：探讨胰岛素强化治疗在呼吸机相关性肺炎（ VAP）并高血糖中的疗效及预后。方法入选2008年1月~2013年12月我院收治的VAP合并高血糖患者90例，分为胰岛素强化治疗组（观察组）与传统治疗组（对照组）。观察两组患者使用呼吸机时间、低血糖发生率、多器官功能障碍综合征（ MODS）发生率以及死亡率。此外，对治疗前后患者体温、白细胞（ WBC ）水平、血清降钙素原（ PCT ）、血清淀粉样蛋白 A （ SAA）水平进行记录分析。结果观察组MODS发生率及死亡率分别为42．22%、33．33%，明显低于对照组的22．22%、15．56%，差异具有显著性（ P〈0．05）；观察组呼吸机时间明显少于对照组（ P〈0．05）；治疗后，观察组体温、WBC、血清PCT、SAA水平等均明显优于对照组，差异均具有统计学意义（均P〈0．05）。结论VAP合并高血糖患者给予胰岛素强化治疗具有较好疗效，能够缩短呼吸机使用时间，降低MODS发生率与死亡率，可以改善相关炎症指标，值得临床推广。

Objective To discuss the curative effect and prognosis of insulin intensive treatment in ventila-tor-associated pneumonia （ VAP） and high blood glucose. Methods 90 patients with VAP and high blood glucose hospitalized from January 2008 to December 2013 in our hospital were randomly divided into the observation group and the control group. Ventilation time, the incidence of hypoglycemia, and the incidence and mortality of multiple organ dysfunction syndrome （ MODS） were observed in the two groups. In addition, body temperature, white blood cell （ WBC） , the levels of serum procalcitonin （ PCT） and amyloid A （ SAA） were recorded and analyzed before and after the treatment. Results The incidence and mortality of MODS were respectively 22. 22% and 15. 56% in the observation group, which were significantly lower than those in the control group （ 42. 22% and 33. 33%） （ P 〈0. 05）. Mechanical ventilation time was significantly shorter in the observation group than in the control group （P〈0. 05）. After the treatment, the improvement of temperature, WBC, serum PCT and SAA level was more pronounced in the observation group than in the control group （P〈0. 05）. Conclusion Patients with VAP and high blood glu-cose should be given intensive insulin treatment, which has better curative effect and can shorten the use time of vent-ilator.