强化胰岛素与常规胰岛素对颅脑创伤患者术后应激性高血糖的疗效比较

Comparison of Effect of Intensive Insulin and Regular Insulin on the Treatment of Postoperative Stress Hyperglycemia in Craniocerebral Traumatic Patients

目的观察并对比胰岛素强化治疗（IIT）与常规治疗对防治颅脑创伤患者术后应激性高血糖（SHG）的疗效。方法将2013年6月至2014年12月海口市第四人民医院重症医学科收治的108例颅脑创伤患者依据随机数字表法分为研究组（56例）和对照组（52例）。两组患者入院后均行血肿清除并去骨瓣减压术,术后对照组对SHG采用常规血糖控制方案,研究组实施IIT方案,即当血糖值超过6.10 mmol/L时采用微量泵注射胰岛素,维持血糖在4.44~6.10 mmol/L水平。比较两组患者术前和术后7 d格拉斯哥昏迷评分（GCS）、急性生理学及慢性健康状况评分（APACHEⅡ）,术前、术后1、术后3 d外周血多形核白细胞（PMN）、肿瘤坏死因子α（TNF-α）、高敏C反应蛋白（hs-CRP）变化,并对比两组患者住院期间并发症及28 d病死率。结果术后7 d,研究组GCS高于对照组[（10.1±1.0）分比（9.4±0.9）分],而APACHEⅡ评分低于对照组[（14±4）分比（17±5）分]（P〈0.05）。术后两组外周血PMN、TNF-α、hs-CRP均呈现先上升后下降的趋势,术后1 d、3 d研究组上述指标均显著低于对照组（P〈0.05）。研究组呼吸机辅助通气时间短于对照组[（8.2±1.7）d比（10.6±2.4）d],差异有统计学意义（P〈0.05）。结论对颅脑创伤患者术后采用IIT控制SHG较常规胰岛素血糖控制能进一步改善患者应激性炎症状态,有助于提高临床疗效。

Objective To observe and compare efficacy between intensive insulin therapy （liT） and conventional insulin therapy in prevention and treatment of postoperative stress hyperglycemia （SHG） of craniocerebral trauma patients. Methods Total of 108 ICU patients with crtmiocerebral trauma in Haikou City Fourth People＇s Hospital from Jun. 2013 to Dec. 201# were randomly divided into study group （56 cases） and control group （52 cases）, both groups were performed hematoma clearance and deeompressive craniectomy ,and the control group was given conventional glucose control scheme for SHG postoperatively, and the study group was given lIT scheme, i. e. when blood glucose value reached over 6. 10 mmol/L, then insulin was given through micro-pump,to maintain blood glucose on the level of 4.44-61 10 mmol/L. Glasgow coma scale（GCS） ,acute physiology and chronic health evaluation（ APACHE 11 ） score before and 7 d after surgery were compared, peripheral blood PMN （%）, TNF-α, hs-CRP variations of the two groups were noted and compared at pre-surgery, and 1 d,3 d post-operation, and complications and 28 d mortality of the two groups were also compared. Results Seven days after surgery, GCS of the study group was significantly high- er than the control group[ （ 10. 1 ± 1.0） scores vs （9.4 ±0. 9） scores] ,whereas the APACHE Ⅱ score was significantly lower than the control group [ （14± 4） scores vs （17± 5 ） scores ] （P 〈 0. 05 ）. The peripheral bleod PMN,TNF-α and hs-CRP values of both groups were increased initially and then decreased, and the study group at postoperative 1 d and 3 d were significantly lower than the control group（P 〈0. 05）. The ven- tilation time of the study group was lower than the control group[ （8.2 ±1.7） d vs （ 10. 6 ±2.4） d] （P 〈 0. 05 ）. Conduslon Compared with conventional insulin glucose control for SHG, Ⅲ scheme for craniocere- bral trauma patients after operation can further alleviate stress inflammation,improve clinical efficacy.