CAJ | 학술논문

目的：观察胰岛素泵强化血糖控制对肺部感染并发呼吸衰竭急危重病人预后的影响。方法选择入住急诊重症监护室（EICU）的 Apache Ⅱ评分＞15分、同时合并高血糖（随机血糖＞11．1 mmol /L）的内科危重病人200例，随机分为强化胰岛素治疗（IIT）组和常规治疗（CIT）组（胰岛素泵血糖控制），其中 IIT 组和 CIT 组各包含肺部感染引起的呼吸衰竭31例和33例，观察2组患者呼吸机、抗生素使用天数，近期死亡率（28 d 内）、入院3 d 及7 d 后的 APACHEⅡ评分、低血糖发生率，院内感染发生率、住院天数、住院费用等指标。结果 IIT 和 CIT 2组年龄、性别构成比、血氧饱和度、氧分压、二氧化碳分压、pH 值、血压、呼吸衰竭类型、血糖、炎症指标、电解质、心功能、肝肾功能、空腹 C 肽、HbAlc、APACHEⅡ评分等指标比较差异无统计学意义（P ＞0．05），具有可比性。IIT 组院内感染发生率、3 d 及7 d 后的 APACHEⅡ评分、死亡率、住院天数、呼吸机、抗生素使用天数、住院费用低于 CIT 组（P ＜0．05）；IIT 组低血糖发生次数明显高于 CIT 组（P ＜0．01），但2组严重低血糖发生次数差异无统计学意义（P ＞0．05）。结论严格强化血糖控制对肺部感染并发呼吸衰竭急危重患者可能带来较多益处，并降低近期死亡率。
목적：관찰이도소빙강화혈당공제대폐부감염병발호흡쇠갈급위중병인예후적영향。방법선택입주급진중증감호실（EICU）적 Apache Ⅱ평분＞15분、동시합병고혈당（수궤혈당＞11．1 mmol /L）적내과위중병인200례，수궤분위강화이도소치료（IIT）조화상규치료（CIT）조（이도소빙혈당공제），기중 IIT 조화 CIT 조각포함폐부감염인기적호흡쇠갈31례화33례，관찰2조환자호흡궤、항생소사용천수，근기사망솔（28 d 내）、입원3 d 급7 d 후적 APACHEⅡ평분、저혈당발생솔，원내감염발생솔、주원천수、주원비용등지표。결과 IIT 화 CIT 2조년령、성별구성비、혈양포화도、양분압、이양화탄분압、pH 치、혈압、호흡쇠갈류형、혈당、염증지표、전해질、심공능、간신공능、공복 C 태、HbAlc、APACHEⅡ평분등지표비교차이무통계학의의（P ＞0．05），구유가비성。IIT 조원내감염발생솔、3 d 급7 d 후적 APACHEⅡ평분、사망솔、주원천수、호흡궤、항생소사용천수、주원비용저우 CIT 조（P ＜0．05）；IIT 조저혈당발생차수명현고우 CIT 조（P ＜0．01），단2조엄중저혈당발생차수차이무통계학의의（P ＞0．05）。결론엄격강화혈당공제대폐부감염병발호흡쇠갈급위중환자가능대래교다익처，병강저근기사망솔。
Objective To explore the influence of intensive glycemic control by insulin pump on prognosis of critically ill patients with lung infection and respiratory failure.Methods In the emergency intensive care unit (EICU),200 critically ill patients with hyperglycemia (A-PACHE II score >15 ,random blood glucose > 11.1 mmol /L)were collected and randomly di-vided into the intensive insulin therapy (IIT)group and the convention insulin therapy(CIT) group(use insulin pump to control blood glucose).IIT group and CIT group included 31 cases and 33 cases of pulmonary infection and respiratory failure.Ventilator and antibiotic use days,short-term mortality (within 28 days),rate of hypoglycemia,nosocomial infection,hospital stay and hospital costs were observed and compared between two groups.Results There was no significant differences between two groups in aspects of age,sex ratio,oxygen saturation,pressure of oxygen, pressure of Carbon dioxide,pH,blood pressure,respiratory failure type,blood glucose,elec-trolytes,inflammation,heart function,liver and kidney function,fasting C peptide,HbAlc and APACHE Ⅱ score(P >0.05).APACHE II score at the time of 3 days and 7 days after admission, nosocomial infection,short-term mortality hospital day and hospital costs (P <0.05)in the IIT group were significantly lower and shorter than the CIT group.The hypoglycemia incidence rate of the IIT group was significantly higher than that of the CIT group (P <0.01).Result of serious hypoglycemia showed no significant difference between the two groups .Conclusion Strict intensive glucose control on pulmonary infection and respiratory failure may bring more benefits for acute and critically ill patients,and it can reduce the short-term mortality rate.