应用改良式波特兰标准方案强化胰岛素治疗对危重症应激性高血糖患者的效应

Effect of Intensive Insulin Therapy with Modified Portland Standard Regimen on Critically Ill Patients with Stress Hyperglycemia

目的探讨应用改良式波特兰标准方案强化胰岛素治疗对危重症应激性高血糖患者的效应。方法将2020年12月至2021年5月感染病科ICU收治的84例应激性高血糖患者作为对照组,护理人员在医嘱指导下对所有患者实施胰岛素强化治疗;选择2021年6~11月感染病科ICU收治的84例应激性高血糖患者作为观察组,我院基于波特兰标准方案与《中国成人住院患者高血糖管理目标专家共识》ICU患者血糖控制指南,修订的改良式波特兰标准方案即《应激性高血糖使用胰岛素治疗方案》,记录两组患者在胰岛素持续静脉泵入后血糖值、血糖波动幅度、血糖达标时间、每日胰岛素用量、低血糖发生率、三管感染发生率、28 d内病死率等情况。结果两组患者在胰岛素强化治疗后,血糖水平均达到正常值;观察组血糖波动幅度、血糖达标时间、每日胰岛素用量与低血糖发生率、三管感染发生率、28 d内病死率均低于对照组(P<0.05)。结论运用改良式波特兰标准方案强化胰岛素治疗,可使危重症应激性高血糖患者的血糖高效、快速地达标,还能降低患者低血糖的发生率、三管感染发生率、28 d内病死率。

Objective To explore the effect of intensive insulin therapy with modified Portland standard regimen on critically ill patients with stress hyperglycemia.Methods A total of 84 patients with stress hyperglycemia in ICU of infectious diseases department from December 2020 to may 2021 were used as the control group.Nurses implemented intensive insulin therapy under the guidance of doctors'orders,84 patients with stress hyperglycemia in ICU of infectious diseases department from June 2021 to November 2021 were selected as the observation group.Based on the Portland standard scheme and the expert consensus on hyperglycemia management objectives of Chinese adult inpatients,our hospital revised the improved Portland standard scheme,that is,the First Affiliated Hospital of Nanjing Medical University according to the insulin treatment plan for stress hyperglycemia,the blood glucose value,blood glucose fluctuation range,blood glucose standard time,daily insulin dosage,hypoglycemia incidence,three tube infection incidence,death rate within 28 days of the two groups were recorded.Results After intensive insulin treatment,the blood glucose and water in the two groups reached the normal value on average,the blood glucose fluctuation range,blood glucose standard time,daily insulin dosage,the incidence of hypoglycemia,the incidence of three tube infection and the mortality within 28 days in the observation group were lower than those in the control group(P<0.05).Conclusion Using the improved Portland standard scheme to strengthen insulin treatment can make the blood glucose of critically ill patients with stress hyperglycemia reach the standard safely,effectively,quickly and stably,reduce the incidence of hypoglycemia,reduce the incidence of three tube infection and reduce the death rate within 28 days.