解放军医药杂志
解放軍醫藥雜誌
해방군의약잡지
Medical & Pharmaceutical Journal of Chinese People's Liberation Army
2015年
10期
47-51
,共5页
杨建海%吴峰%李辉%岳悦
楊建海%吳峰%李輝%嶽悅
양건해%오봉%리휘%악열
应激性高血糖%危重病%心功能%胰岛素
應激性高血糖%危重病%心功能%胰島素
응격성고혈당%위중병%심공능%이도소
Stress hyperglycemia%Critical illness%Cardiac function%Insulin
目的 探讨应激性高血糖( SHG)对ICU危重症患者心功能的影响及给予强化胰岛素治疗的效果. 方法 对2010年12月—2014年9月解放军254医院收治的80例非糖尿病危重症患者入院即刻监测血糖,按血糖值分为SHG组(56例)和血糖正常组(24例),将SHG组随机分为常规治疗组(28例)和强化组(28例). 比较SHG及血糖正常者入院时心功能、住院情况及预后;并观察常规治疗组和强化组治疗前后心功能改善情况. 结果 SHG组右房压( RAP)、肺动脉压( PAP)、肺动脉楔压( PAWP)、脑利钠肽( BNP)明显高于血糖正常组,心排血量( CO)、心脏指数(CI)、氧分压(PaO2)和二氧化碳分压(PaCO2)低于血糖正常组(P<0. 05). 强化组治疗后RAP、PAP、PAWP、BNP低于治疗前和对照组,CO、CI、PaO2、PaCO2 高于治疗前和对照组(P<0. 05). SHG患者ICU住院天数、应用呼吸机人数、机械通气时间和病死率均较血糖正常组增加,但强化组较常规治疗组降低( P<0. 05 ). 结论 SHG对危重症患者的心功能有明显影响,给予胰岛素强化治疗可明显改善心功能.
目的 探討應激性高血糖( SHG)對ICU危重癥患者心功能的影響及給予彊化胰島素治療的效果. 方法 對2010年12月—2014年9月解放軍254醫院收治的80例非糖尿病危重癥患者入院即刻鑑測血糖,按血糖值分為SHG組(56例)和血糖正常組(24例),將SHG組隨機分為常規治療組(28例)和彊化組(28例). 比較SHG及血糖正常者入院時心功能、住院情況及預後;併觀察常規治療組和彊化組治療前後心功能改善情況. 結果 SHG組右房壓( RAP)、肺動脈壓( PAP)、肺動脈楔壓( PAWP)、腦利鈉肽( BNP)明顯高于血糖正常組,心排血量( CO)、心髒指數(CI)、氧分壓(PaO2)和二氧化碳分壓(PaCO2)低于血糖正常組(P<0. 05). 彊化組治療後RAP、PAP、PAWP、BNP低于治療前和對照組,CO、CI、PaO2、PaCO2 高于治療前和對照組(P<0. 05). SHG患者ICU住院天數、應用呼吸機人數、機械通氣時間和病死率均較血糖正常組增加,但彊化組較常規治療組降低( P<0. 05 ). 結論 SHG對危重癥患者的心功能有明顯影響,給予胰島素彊化治療可明顯改善心功能.
목적 탐토응격성고혈당( SHG)대ICU위중증환자심공능적영향급급여강화이도소치료적효과. 방법 대2010년12월—2014년9월해방군254의원수치적80례비당뇨병위중증환자입원즉각감측혈당,안혈당치분위SHG조(56례)화혈당정상조(24례),장SHG조수궤분위상규치료조(28례)화강화조(28례). 비교SHG급혈당정상자입원시심공능、주원정황급예후;병관찰상규치료조화강화조치료전후심공능개선정황. 결과 SHG조우방압( RAP)、폐동맥압( PAP)、폐동맥설압( PAWP)、뇌리납태( BNP)명현고우혈당정상조,심배혈량( CO)、심장지수(CI)、양분압(PaO2)화이양화탄분압(PaCO2)저우혈당정상조(P<0. 05). 강화조치료후RAP、PAP、PAWP、BNP저우치료전화대조조,CO、CI、PaO2、PaCO2 고우치료전화대조조(P<0. 05). SHG환자ICU주원천수、응용호흡궤인수、궤계통기시간화병사솔균교혈당정상조증가,단강화조교상규치료조강저( P<0. 05 ). 결론 SHG대위중증환자적심공능유명현영향,급여이도소강화치료가명현개선심공능.
Objective To investigate the effect of stress hyperglycemia ( SHG) on cardiac function and effective-ness of insulin intensive therapy for critical patients in ICU. Methods A total of 80 critical non-diabetic patients admit-ted to ICU were recruited in this study, and blood sugar levels were detected immediately after admission. The patients were divided into SHG patients (n=56) and the euglycemia group (n=24) according to detection results, and the SHG patients were randomly divided into the routine treatment subgroup (n=28) and the intensive treatment subgroup (n=28). Cardiac function, hospitalization condition and prognosis in the two groups were compared upon admission, and the improvement of cardiac function between and after the routine and the intensive treatments was observed. Results In SHG group, the levels of right atrial pressure ( RAP) , pulmonary arterial pressure ( PAP) , pulmonary arterial wedge pressure (PAWP) and brain natriuretic peptide ( BNP) were significantly higher, while the levels of cardiac output ( CO) , cardiac index ( CI) , partial pressure of oxygen ( PaO2 ) and partial pressure of carbondioxide ( PaCO2 ) were sig-nificantly lower than those in the euglycemia group. In the intensive treatment subgroup, the levels of RAP, PAP, PAWP and BNP were significantly lower, while the levels of CO, CI, PaO2 and PaCO2 were significantly higher than those before the treatment and in the routine treatment subgroup (P<0. 05). In the SHG group, the hospital days, total number of patients using mechanical ventilation, the time of mechanical ventilation and mortality rate were increased, compared with those in the euglycemia group, while the indexes in the intensive treatment subgroup were significantly decreased, com-pared with those in the routine treatment subgroup (P<0. 05). Conclusion The SHG can obviously affect the cardiac function of patients in ICU, and insulin intensive therapy can markedly improve the cardiac function.
