胰岛素强化干预在ICU急危重症患者中的应用效果

Application effect of the intensive insulin intervention on critically ill patients in ICU

目的探讨胰岛素强化干预在急诊重症监护室(ICU)急危重症患者中的应用效果。方法选取2021年1月至12月上饶市人民医院收治的60例存在应激性高血糖的ICU急危重症患者作为研究对象,采取随机数字表法分成常规治疗组(目标血糖控制在6.1~8.1 mmol/L)和强化治疗组(目标血糖控制在4.1~6.1 mmol/L),每组各30例,常规治疗组采用常规胰岛素治疗干预方式进行治疗,强化治疗组采用胰岛素强化治疗,比较两组病情指标、治疗前后血糖管理效果及预后。结果强化治疗组ICU停留时间、心电监护时间、胰岛素泵入时间、出院时间短于常规治疗组,差异有统计学意义(P<0.05)。治疗后,两组的空腹血糖(FPG)水平低于本组治疗前,胰岛素敏感指数(ISI)、胰岛素抵抗指数(HOMA-IR)水平高于本组治疗前,差异有统计学意义(P<0.05);治疗后,强化治疗组的FPG水平低于常规治疗组,ISI、HOMA-IR水平高于常规治疗组,差异有统计学意义(P<0.05)。两组的低血糖、呼吸困难、院内感染、死亡等预后不良总发生率比较,差异无统计学意义(P>0.05)。结论胰岛素强化干预对ICU急危重症患者应激性高血糖病情及预后有较好的改善效果。

Objective To investigate the application effect on the intensive insulin intervention on critically ill patients in Emergency ICU.Methods A total of 60 ICU critically ill patients with stress hyperglycemia admitted to ShangRao People′s Hospital from January to December 2021 were selected as research objects.They were randomly divided into routine treatment group(target blood sugar controlled at 6.1-8.1 mmol/L)and intensive treatment group(target blood sugar controlled at 4.1-6.1 mmol/L),with 30 patients in each group.The routine treatment group was treated with conventional insulin treatment intervention,and the intensive treatment group was treated with insulin intensive therapy.The disease indicators,blood glucose management effect before and after treatment and prognosis were compared between the two groups.Results The ICU stay time,electrocardiogram monitoring time,insulin pumping time and discharge time in intensive treatment group were shorter than those in conventional treatment group,with statistically significant differences(P<0.05).After treatment,the fasting plasma glucos(FPG)level of the two groups was lower than that before treatment,and the insulin sensitivity index(ISI)and insulin resistance index(HOMA-IR)levels were higher than those before treatment,with statistically significant differences(P<0.05).After treatment,the FPG level in intensive treatment group was lower than that in conventional treatment group,and the ISI and HOMA-IR levels in intensive treatment group were higher than those in conventional treatment group,with statistically significant differences(P<0.05).There was no statistically significant difference in the total incidence of poor prognosis such as hypoglycemia,dyspnea,nosocomial infection and death between the two groups(P>0.05).Conclusion Intensive insulin intervention can improve stress hyperglycemia and prognosis of critically ill patients in ICU.