动态血糖监测联合胰岛素强化治疗高血糖危重患者的临床研究

Clinical trial of dynamic blood glucose monitoring combined with insulin intensive therapy in critically ill patients with hyperglycemia

目的观察动态血糖监测联合胰岛素强化治疗对重症监护室(ICU)高血糖危重患者的临床疗效。方法我院重症监护室收治的高血糖危重患者135例,随机分为对照组67例和试验组68例。对照组患者每天进行3次指尖血糖监测,用注射泵持续静脉泵入胰岛素2~4 U·h^(-1)常规治疗。试验组患者进行动态血糖监测(每6 h对血糖变化进行记录),同时联合胰岛素强化治疗(当患者初次血糖>12.1 mmol·L^(-1)时,静脉输注4 U·h^(-1)胰岛素,若血糖未能下降,适当增加1.5~2.0 U·h^(-1)的胰岛素用量)。2组患者均连续治疗2周。观察2组患者在不同时间的FBG值、ICU住院时间、平均机械通气时间、病死情况和低血糖发生情况。结果试验组在治疗后3,5,7 d的FBG分别为(6.34±1.48),(5.73±1.23),(5.24±0.86)mmol·L^(-1),对照组分别为(8.76±2.36),(8.46±2.19),(7.59±2.19)mmol·L^(-1),差异均有统计学意义(均P<0.05)。试验组ICU住院时间、平均机械通气时间分别为(8.63±5.72),(6.25±4.61)d,对照组分别为(9.78±6.34),(6.75±4.78)d,差异均无统计学意义(均P>0.05)。试验组病死例数7例(10.29%),对照组11例(16.41%),差异无统计学意义(P>0.05)。试验组发生低血糖6例次(8.82%),对照组发生14例(20.89%),差异有统计学意义(P<0.05)。结论对重症监护室高血糖危重患者进行动态血糖监测联合胰岛素强化治疗,能够更精准地掌握高血糖危重患者的血糖变化情况,更科学地制定胰岛素的用量,快速降低患者的血糖并降低低血糖的发生率,具有很好的临床效果。

Objective To observe the clinical effect of dynamic blood glucose monitoring combined with intensive insulin therapy in critically ill patients with hyperglycemia in intensive care unit（ ICU）. Methods A total of 135 cases of critically ill patients with severe hyperglycemia were randomly divided into control group（ n = 67） and treatment group（ n = 68）. Control group was given fingertip blood glucose monitoring,3 times a day combined with syringe pump continuous intravenous 2-4 U·h^-1 insulin. Treatment group was given dynamic blood glucose monitoring（ every 6 h on blood glucose changes recorded） combined with insulin intensive treatment（ when patients＇ initial blood glucose 12. 1 mmol·L^-1,the patients were intravenous infusion 4 U·h^-1 insulin,if the blood glucose did not decline,the appropriate increase in 1. 5-2. 0U·h^-1 insulin）. Two groups were treated continuously for 2 weeks. The fasting blood glucose（ FBG）,ICU hospitalization time,mean mechanical ventilation time,mortality and hypoglycemia were observed in two groups. Results After 3,5,7 d treatment,the FBG in treatment group were（ 6. 34 ± 1. 48）,（ 5. 73 ± 1. 23）,（ 5. 24 ± 0. 86）mmol·L^-1,had significant difference with those in control group,which were（ 8. 76 ± 2. 36）,（ 8. 46 ± 2. 19）,（ 7. 59 ± 2. 19） mmol·L^-1（ P〈0. 05）. The ICU hospitalization time,mean mechanical ventilation time in treatment group were（ 8. 63 ± 5. 72）,（ 6. 25 ± 4. 61） d,had no significant difference with those in control group,which were（ 9. 78 ± 6. 34） and（ 6. 75 ± 4. 78） d（ P〈0. 05）. There were 7 cases（ 10. 29%） of mortality in treatment group and11 cases（ 16. 41%） in control group,with no significant difference（ P〈0. 05）. There were 6 cases（ 8. 82%） of hypoglycemia in treatment group and 14 cases（ 20. 89%） in control group,with no significant difference（ P〈0. 05）.Conclusion In the intensive care unit,hyperglycemia patients with dynamic blood glucose monitoring combined with insulin intensive treatment can more accurately grasp hyperglycemia critically ill patients＇ blood glucose changes,and then more scientific development of insulin use,can quickly reduce the patients＇ blood glucose and reduce the incidence of hypoglycemia,has a very good clinical efficacy.