CAJ | 학술논문

目的：分析探讨危重症伴应激性高血糖老年患者的血糖控制水平对其预后及血清白细胞介素6（IL－6）、C反应蛋白（CRP）水平的影响。方法选择2008年3月至2014年9月在武汉市第三医院接受治疗的86例危重症伴应激性高血糖老年患者，使用随机数字表分成观察组（44例）和对照组（42例）。两组患者均应用胰岛素进行治疗，对照组患者的血糖水平控制在8.0～10.0 mmol／L，而观察组患者的血糖水平则控制在4.4～7.8 mmol／L。观察、比较两组患者的临床相关指标、不良事件以及血清IL－6、CRP水平的变化情况。结果治疗后，观察组患者胰岛素使用量、低血糖发生率显著高于对照组[（42±8） U／d比（25±6） U／d，15.9％（7／44）比2.4％（1／42），P＜0.05]，胰岛素应用时间、重症病房治疗时间显著短于对照组[（8±3） d比（12±5） d，（10±4） d比（14±6） d]，感染发生率显著低于对照组[6.8％（3／44）比23.8％（10／42），P＜0.05]；但是两组患者在病死率和多器官功能障碍综合征发生率比较的差异无统计学意义（P＞0.05）；两组患者的血清IL－6、CRP水平都较治疗前显著下降（P＜0.05），治疗后，观察组IL－6、CRP水平显著低于对照组[（28±10）μg／L比（44±14）μg／L，（43±18） mg／L比（87±24） mg／L，P＜0.01]。结论危重症伴应激性高血糖老年患者保持较低的血糖控制水平，会缩短重症病房治疗时间、减少感染的发生，但是并不会改善患者病死以及发生多器官功能障碍综合征的情况，并且还可能增加患者发生低血糖的情况。
목적：분석탐토위중증반응격성고혈당노년환자적혈당공제수평대기예후급혈청백세포개소6（IL－6）、C반응단백（CRP）수평적영향。방법선택2008년3월지2014년9월재무한시제삼의원접수치료적86례위중증반응격성고혈당노년환자，사용수궤수자표분성관찰조（44례）화대조조（42례）。량조환자균응용이도소진행치료，대조조환자적혈당수평공제재8.0～10.0 mmol／L，이관찰조환자적혈당수평칙공제재4.4～7.8 mmol／L。관찰、비교량조환자적림상상관지표、불량사건이급혈청IL－6、CRP수평적변화정황。결과치료후，관찰조환자이도소사용량、저혈당발생솔현저고우대조조[（42±8） U／d비（25±6） U／d，15.9％（7／44）비2.4％（1／42），P＜0.05]，이도소응용시간、중증병방치료시간현저단우대조조[（8±3） d비（12±5） d，（10±4） d비（14±6） d]，감염발생솔현저저우대조조[6.8％（3／44）비23.8％（10／42），P＜0.05]；단시량조환자재병사솔화다기관공능장애종합정발생솔비교적차이무통계학의의（P＞0.05）；량조환자적혈청IL－6、CRP수평도교치료전현저하강（P＜0.05），치료후，관찰조IL－6、CRP수평현저저우대조조[（28±10）μg／L비（44±14）μg／L，（43±18） mg／L비（87±24） mg／L，P＜0.01]。결론위중증반응격성고혈당노년환자보지교저적혈당공제수평，회축단중증병방치료시간、감소감염적발생，단시병불회개선환자병사이급발생다기관공능장애종합정적정황，병차환가능증가환자발생저혈당적정황。
Objective To analyze and discuss the effects of glycemic control on interleukin-6(IL-6),C reactive protein(CRP)levels of elderly patients with critically disease and stress hyperglycemia.Methods A total of 86 elderly patients with critically disease and stress hyperglycemia treated in Wuhan City Third Hos-pital from Mar.2008 to Sep.2014 were included,and were divided into observation group and control group according to random number table method.The patients of both groups were treated with insulin,the blood glucose levels of the control group was controlled between 8.0-10.0 mmol/L,and of the observation group was controlled between 4.4-7.8 mmol/L.The relevant clinical indicators,adverse events,and changes in serum IL-6,CRP of the two groups were observed and compared.Results After the treatment,the insulin dosage and the incidence of hypoglycemia in the observation group were significantly higher than those of the control group[(42 ±8) U/d vs (25 ±6) U/d,15.9%(7/44) vs 2.4%(1/42),P<0.05]; the times of insulin application,the treatment time of intensive care and the incidence of infection in the observation group were significantly lower than the control group[(8 ±3) d vs (12 ±5) d,(10 ±4) d vs (14 ±6) d,6.8%vs 23.8%,P<0.05]; there was no statistically significant difference in the mortality and incidence of mul-tiple organ dysfunction syndrome between the two groups(P>0.05); the levels of IL-6 and CRP in both groups were all significantly decreased than before treatment (P<0.05),and the observation group got more significant decline[(28 ±10) μg/L vs (44 ±14) μg/L,(43 ±18) mg/L vs (87 ±24) mg/L,P<0.01]. Conclusion By maintaining at a lower glycemic level,the elderly patients with critically disease and stress hyperglycemia can get some shorter treatment time of intensive care and less incidence of infection ,but cannot get improved mortality and incidence of multiple organ dysfunction syndrome of the patients , and may get more hypoglycemia.