天津医药
天津醫藥
천진의약
TIANJIN MEDICAL JOURNAL
2014年
4期
356-358
,共3页
创伤和损伤%危重病%高血糖症%胰岛素%低血糖症%强化胰岛素治疗
創傷和損傷%危重病%高血糖癥%胰島素%低血糖癥%彊化胰島素治療
창상화손상%위중병%고혈당증%이도소%저혈당증%강화이도소치료
wounds and injuries%critical illness%hyperglycemia%insulin%hypoglycemia%intensive insulin therapy
目的：对危重创伤应激性高血糖患者采用不同目标血糖控制水平的胰岛素治疗，探讨其有效性和安全性。方法将153例危重创伤患者随机分为强化胰岛素治疗（IIT）组、胰岛素优化治疗（NST）组和胰岛素常规治疗（CIT）组，各51例。3组血糖控制水平分别为4.0~6.1 mmol/L、6.2~8.3 mmol/L和9.9~11.1 mmol/L。比较3组患者每日胰岛素用量、低血糖发生率、终点血糖、出ICU时APACHEⅡ评分、机械通气时间、住ICU时间、并发症发生率及病死率等。结果 IIT组每日胰岛素用量（U/d：60.2±15.2）、低血糖发生率（15.7%）均高于NST组和CIT组，NST组每日胰岛素用量高于CIT组（U/d：54.4.±15.4 vs 49.4±16.1，P＜0.05），低血糖发生率与CIT组（7.8%vs 5.8%）差异无统计学意义。IIT组终点血糖（5.4±0.8）mmol/L低于NST组（7.6±0.7）mmol/L和CIT组（10.4±0.9）mmol/L，NST组低于CIT组（均P＜0.05）。NST组出ICU时APACHEⅡ评分（9.3±7.5）分、机械通气时间（12.9±18.6）h和住ICU时间（4.9±3.3）d均最短（均P＜0.05），IIT组与CIT组间差异均无统计学意义。3组并发症发生率和病死率差异均无统计学意义。结论胰岛素治疗危重创伤患者应激性高血糖，将目标血糖控制在6.2~8.3 mmol/L效果最佳。
目的：對危重創傷應激性高血糖患者採用不同目標血糖控製水平的胰島素治療，探討其有效性和安全性。方法將153例危重創傷患者隨機分為彊化胰島素治療（IIT）組、胰島素優化治療（NST）組和胰島素常規治療（CIT）組，各51例。3組血糖控製水平分彆為4.0~6.1 mmol/L、6.2~8.3 mmol/L和9.9~11.1 mmol/L。比較3組患者每日胰島素用量、低血糖髮生率、終點血糖、齣ICU時APACHEⅡ評分、機械通氣時間、住ICU時間、併髮癥髮生率及病死率等。結果 IIT組每日胰島素用量（U/d：60.2±15.2）、低血糖髮生率（15.7%）均高于NST組和CIT組，NST組每日胰島素用量高于CIT組（U/d：54.4.±15.4 vs 49.4±16.1，P＜0.05），低血糖髮生率與CIT組（7.8%vs 5.8%）差異無統計學意義。IIT組終點血糖（5.4±0.8）mmol/L低于NST組（7.6±0.7）mmol/L和CIT組（10.4±0.9）mmol/L，NST組低于CIT組（均P＜0.05）。NST組齣ICU時APACHEⅡ評分（9.3±7.5）分、機械通氣時間（12.9±18.6）h和住ICU時間（4.9±3.3）d均最短（均P＜0.05），IIT組與CIT組間差異均無統計學意義。3組併髮癥髮生率和病死率差異均無統計學意義。結論胰島素治療危重創傷患者應激性高血糖，將目標血糖控製在6.2~8.3 mmol/L效果最佳。
목적：대위중창상응격성고혈당환자채용불동목표혈당공제수평적이도소치료，탐토기유효성화안전성。방법장153례위중창상환자수궤분위강화이도소치료（IIT）조、이도소우화치료（NST）조화이도소상규치료（CIT）조，각51례。3조혈당공제수평분별위4.0~6.1 mmol/L、6.2~8.3 mmol/L화9.9~11.1 mmol/L。비교3조환자매일이도소용량、저혈당발생솔、종점혈당、출ICU시APACHEⅡ평분、궤계통기시간、주ICU시간、병발증발생솔급병사솔등。결과 IIT조매일이도소용량（U/d：60.2±15.2）、저혈당발생솔（15.7%）균고우NST조화CIT조，NST조매일이도소용량고우CIT조（U/d：54.4.±15.4 vs 49.4±16.1，P＜0.05），저혈당발생솔여CIT조（7.8%vs 5.8%）차이무통계학의의。IIT조종점혈당（5.4±0.8）mmol/L저우NST조（7.6±0.7）mmol/L화CIT조（10.4±0.9）mmol/L，NST조저우CIT조（균P＜0.05）。NST조출ICU시APACHEⅡ평분（9.3±7.5）분、궤계통기시간（12.9±18.6）h화주ICU시간（4.9±3.3）d균최단（균P＜0.05），IIT조여CIT조간차이균무통계학의의。3조병발증발생솔화병사솔차이균무통계학의의。결론이도소치료위중창상환자응격성고혈당，장목표혈당공제재6.2~8.3 mmol/L효과최가。
Objective To investigate the effect and safety of intensive insulin therapy on patients who had stress hy-perglycemia induced by critical trauma, when different blood glucose was aimed in surgery intensive care unit (SICU). Methods We retrospectively analyzed SICU patients who were admitted between 2010.1-2012.7 with admission blood glucose and 30 minutes blood glucose both over 11.1 mmol/L ,and without known history of diabetes. In total, 153 pa-tients were set into three groups according to their target blood glucose:intensive insulin therapy (IIT) group with target blood glucose of 4.0-6.1 mmol/L;NICE SUGAR (NST) group with target blood glucose of 6.2-8.3 mmol/L;conventional in-sulin therapy(CIT)group with target blood glucose of 9.9-11.1 mmol/L. Each group had 51 patients. To collect data from these three groups of patients,we compared daily insulin doses , hypoglycemia incidence, final blood glucose, APACHEⅡscores upon discharging from ICU, time of the ventilatory support, length of staying in ICU, morbidity and mortality rate. Results Comparing these three groups, daily insulin dosage and hypoglycemia incidence, were significantly lower in NST and CIT group than in IIT group. Daily insulin dosage was higher in NST group than in CIT group;no significant difference of hypoglycemia incidence was shown between NST group and CIT group. The final blood glucose was lowest in IIT group and highest in CIT group (P<0.05). APACHE II score was 9.3±7.5 upon discharge from ICU in NST group. Ventilation time and duration of ICU admission both were shortest in NST group but show no significant difference between IIT and CIT group . No significant difference of complicate incidence and mortality rate was indicated among all three groups. Conclusion In patient with stress hyperglycemia induced by critical trauma,maintaining the patients’final blood glucose between 6.2-8.3 mmol/L can effectively control the stress hyperglycemia,improve prognosis and reduce the mortality of hypoglycemia.
