CAJ | 학술논문

目的研究强化胰岛素治疗方案对严重脓毒症呼吸衰竭合并高血糖患者预后和并发症的影响。方法选择严重脓毒症呼吸衰竭并发高血糖症且住院超过3d的患者142例，完全随机分为强化胰岛素治疗组（将血糖严格控制在4.4～6.1 mmol/L）和常规治疗组（将血糖控制在10.0 ～11.1 mmol/L）。观察比较2组ICU病死率、总住院病死率、ICU住院时间和总住院时间。结果与常规治疗组比较，强化胰岛素治疗组的ICU住院大数、总住院大数和呼吸机治疗时间均明显缩短[(12±3)d比(15±4)d；(19±6)d比(24±7)d；(10±2)d比(14±3)d;P ＜0.01]，ICU病死率和总住院病死率降低[22.5％ (16/71)比42.3％(30/71)；36.6％ (26/71)比54.9％ (39/71)；P＜0.05]，继发性肾损害减少[8.5％(6/71)比19.7％( 14/71)；P＜0.05]。结论治疗严重脓毒症合并高血糖患者时，不应考虑其既往是否有糖尿病史，而是应该应用强化胰岛素治疗方案将血糖降至正常范围。
목적 연구강화이도소치료방안대엄중농독증호흡쇠갈합병고혈당환자예후화병발증적영향。방법 선택엄중농독증호흡쇠갈병발고혈당증차주원초과3d적환자142례，완전수궤분위강화이도소치료조（장혈당엄격공제재4.4～6.1 mmol/L）화상규치료조（장혈당공제재10.0 ～11.1 mmol/L）。관찰비교2조ICU병사솔、총주원병사솔、ICU주원시간화총주원시간。결과 여상규치료조비교，강화이도소치료조적ICU주원대수、총주원대수화호흡궤치료시간균명현축단[(12±3)d비(15±4)d；(19±6)d비(24±7)d；(10±2)d비(14±3)d;P ＜0.01]，ICU병사솔화총주원병사솔강저[22.5％ (16/71)비42.3％(30/71)；36.6％ (26/71)비54.9％ (39/71)；P＜0.05]，계발성신손해감소[8.5％(6/71)비19.7％( 14/71)；P＜0.05]。결론 치료엄중농독증합병고혈당환자시，불응고필기기왕시부유당뇨병사，이시응해응용강화이도소치료방안장혈당강지정상범위。
Objective To investigate the effect of intensive insulin therapy on severe sepsis. Methods In a prospective,randomized controlled study, adult patients who were considered to need intensive care for at least three days were enrolled. On admission, one hundred and forty-two severe sepsis patients with hyperglycemia were randomly dividided into intensive insulin therapy group ( maintenance of blood glucose at a level between 4.4 and 6.1 mmol/L) or conventional therapy group ( infusion tapered when the level of glucose at a level between 10.0 and 11.1 mmol/L). Mortality in the ICU, mortality in the hospital, days weaning from mechanical ventilation, days in the ICU and in the hospital, new kidney injury and new hepatic injury during intensive care were observed. Results The days in the ICU (12 ±3 days vs 15 ±4 days) ,in the hospital ( 19 ±6 days vs 24 ±7 days) and the days weaning from mechanical ventilation (10 ± 2 days vs 14 ± 3 days) in intensive insulin therapy group were significantly reduced than those in the conventional therapy group (P ＜ 0.01 ). The mortality in the ICU (22.5％ in the intensive insulin therapy group vs 42.3％ in the conventional therapy group, P ＜0.05 ) and in the hospital (36.6％ vs 54.9％, P ＜0.05 ) were also significantly reduced. Morever,morbidity was significantly reduced by the prevention of newly acquired kidney injury (8.5％ vs 19.7％, P ＜ 0.05). Conclusion Glucose levels in severe sepsis patients should be controlled through implementation of intensive insulin therapy to achieve normoglycemia, regardless of a history of diabetes.