CAJ | 학술논문

目的：探索脓毒症并发高血糖时血糖控制的方法。方法收集2011年3月~2014年2月湖南省儿童医院急救中心157例并发高血糖的脓毒症患儿，按入院时血糖分组。第1组：血糖≥15 mmol/L时，限糖，静脉注射胰岛素0.1U/kg，每隔2 h测血糖；第2组：当10≤血糖＜15 mmol/L，皮下注射胰岛素0.1U/kg，限制外源性高浓度葡萄糖输注（仅用5%葡萄糖），每输注葡萄糖6 g，加胰岛素1U皮下注射，间隔2 h测血糖；第3组：当7.0≤血糖＜10mmol/L，每输注葡萄糖6 g，加胰岛素1U皮下注射。主要观察指标为危重病例评分、血糖水平、胰岛素使用前后血糖波动范围、胰岛素、C肽、HOMA-IR和HOMA-β等。结果3组患儿血糖均呈下降趋势；3组比较，危重病例评分（PCIS）PCIS、C肽、PH值、血乳酸、PCT、HOMA-IR、HOMA-β、第1天和第3天血糖、血糖波动值差异有统计学意义（P＜0.01或0.05）；胰岛素治疗后，112例患儿血糖呈下降趋势，45例患儿血糖上升或反复，有7例发生不同程度低血糖，但仅1例患儿血糖低于2.2 mmol/L。结论在监测同时，按高血糖程度采用上述限糖和小剂量胰岛素治疗方案安全有效。
목적：탐색농독증병발고혈당시혈당공제적방법。방법수집2011년3월~2014년2월호남성인동의원급구중심157례병발고혈당적농독증환인，안입원시혈당분조。제1조：혈당≥15 mmol/L시，한당，정맥주사이도소0.1U/kg，매격2 h측혈당；제2조：당10≤혈당＜15 mmol/L，피하주사이도소0.1U/kg，한제외원성고농도포도당수주（부용5%포도당），매수주포도당6 g，가이도소1U피하주사，간격2 h측혈당；제3조：당7.0≤혈당＜10mmol/L，매수주포도당6 g，가이도소1U피하주사。주요관찰지표위위중병례평분、혈당수평、이도소사용전후혈당파동범위、이도소、C태、HOMA-IR화HOMA-β등。결과3조환인혈당균정하강추세；3조비교，위중병례평분（PCIS）PCIS、C태、PH치、혈유산、PCT、HOMA-IR、HOMA-β、제1천화제3천혈당、혈당파동치차이유통계학의의（P＜0.01혹0.05）；이도소치료후，112례환인혈당정하강추세，45례환인혈당상승혹반복，유7례발생불동정도저혈당，단부1례환인혈당저우2.2 mmol/L。결론재감측동시，안고혈당정도채용상술한당화소제량이도소치료방안안전유효。
Objective To observe the safety and effct of insulin application in children of sepsis complicated with hyperglycemia. Methods 157 children of sepsis complicated with hyperglycemia, 97 boys and 60 girls, aged 1 month ~10 years and 1 month, were divided into 3 groups according to their blood glucose (BG) on admission: Group 1 with the BG ≥15 mmol/L that was to receive insulin 0.1 U/kg, I.V. and undergo BG examination every 2 hours, Group 2 with (10 mmol/L≤BG<15 mmol/L) receiving subcutaneous injection of insulin 0.1 U/kg and insulin 1 U in addition for every 6g glucose in 5% glucose injection, and undergo BG examination every 2 hours; and Group 3 (7.0 mmol/L≤BG<10 mmol/L). that received subcutaneous injection of I U insulin for each infusion of 6g glucose. The levels of pediatric clinical Illness score (PCIS), BG, insulin, peptide C, and lactic acid were measured for 3 days. HOMA-IR and HOMA-β were calculated. Results The glucose levels declined in these 3 groups. , the PCIS, eptide C, PH, lactate, PCT, HOMA-IR, HOMA-β, the blood glucose at the first day and the third day, and blood glucose fluctuation were different among the three groups(P <0.01or 0.05).After use of insulin, the BG levels decreased in 112 patients, increased of fluctuated in 45 patients. There were not significant differences in other parameters among these 3 griuos. were increase or wave, 7 patients were hypoglycemia, and only 1 patients’blood glucose less than 2.2mmol/l. Conclusions While monitoring the levels of blood glucose, the methods of limiting sugar and low dosage insulin were effective to sepsis patients with hyperglycemia.