CAJ | 학술논문

目的：探讨强化胰岛素治疗（intensive insulin therapy，IIT）在重型颅脑损伤（severe traumatic brain injury，sTBI）中的临床应用价值。方法对200例sTBI患者（GCS评分3～8分），入院后随机分为IIT组100例及常规胰岛素治疗（conventional insulin treatment ，CIT）组100例。 IIT组血糖（blood glucose，BG）控制在3.9～6.1 mmol／L，CIT组血糖控制在8.3～10.1 mmol／L。患者入院后即开始采用持续静脉泵入胰岛素对血糖进行控制，记录两组患者平均血糖水平、胰岛素用量、低血糖发生率，于伤后6个月时根据GOS评估法判断疗效（分为良好、中残、重残、植物生存和死亡）。结果治疗期IIT组BG低于CIT组（ P＜0.01），低BG发生率、单位时间胰岛素用量均高于CIT组（ P＜0.05或P＜0.01）。伤后6个月，两组在良好、中残、重残、植物生存和死亡例数比较差异无统计学意义（ P＞0.05）。结论强化胰岛素治疗并不能改善sTBI的预后，且增加了低BG发生率，血糖控制在8.3～10.1 mmol／L是比较理想的水平。
목적：탐토강화이도소치료（intensive insulin therapy，IIT）재중형로뇌손상（severe traumatic brain injury，sTBI）중적림상응용개치。방법대200례sTBI환자（GCS평분3～8분），입원후수궤분위IIT조100례급상규이도소치료（conventional insulin treatment ，CIT）조100례。 IIT조혈당（blood glucose，BG）공제재3.9～6.1 mmol／L，CIT조혈당공제재8.3～10.1 mmol／L。환자입원후즉개시채용지속정맥빙입이도소대혈당진행공제，기록량조환자평균혈당수평、이도소용량、저혈당발생솔，우상후6개월시근거GOS평고법판단료효（분위량호、중잔、중잔、식물생존화사망）。결과치료기IIT조BG저우CIT조（ P＜0.01），저BG발생솔、단위시간이도소용량균고우CIT조（ P＜0.05혹P＜0.01）。상후6개월，량조재량호、중잔、중잔、식물생존화사망례수비교차이무통계학의의（ P＞0.05）。결론강화이도소치료병불능개선sTBI적예후，차증가료저BG발생솔，혈당공제재8.3～10.1 mmol／L시비교이상적수평。
Objective To discuss the clinical application value of intensive insulin therapy ( IIT) in severe traumatic brain injury(sTBI).Methods Two hundred patients with sTBI (GCS 3~8) were randomly divided into the intensive insulin therapy group(IIT,n=100 cases)and the conventional insulin treatment group (CIT,n=100 ca-ses) .IIT group′s blood glucose ( BG) was controlled in 3.9~6.1 mmol/L, CIT group′s blood glucose was controlled in 8.3~10.1 mmol/L.The patients after admission were treated using continuous intravenous infusion of insulin to control blood glucose .The average blood glucose levels , insulin dosage , incidence of hypoglycemia in two groups were recorded .Six months after injury , the efficacy was evaluated according to GOS valuation method including 5 grades:good, moderate disability, severe disability, vegetative state, and death.Results During treatment BG in IIT group was lower than that in CIT group ( P<0.01 ) , the incidence of hypoglycemia , average hourly insulin dosage in IIT group were higher than those in CIT group ( P<0.05 or P<0.01 ) .After 6 months there were no statistically signifi-cant difference between the two groups in the efficacy including good , moderate disability , severe disability , vegeta-tive state, and death(P>0.05).Conclusion IIT does not improve the prognosis of patients with sTBI , but increase the incidence of hypoglycemia , blood glucose is controlled in 8.3~10.1 mmol /L is ideal.