危重创伤患者应激性高血糖胰岛素强化治疗再研究

危重创伤患者应激性高血糖胰岛素强化治疗再研究

李林

天津第四中心医院ICU病房

收稿日期:2013-03-29 修回日期:2013-11-25 出版日期:2014-04-15 发布日期:2014-04-15
通讯作者: 李林

Rediscovery the Effect of Intensive Insulin Therapy on Stress Hyperglycemia in Critical Trauma Patients

Received:2013-03-29 Revised:2013-11-25 Published:2014-04-15 Online:2014-04-15

李林. 危重创伤患者应激性高血糖胰岛素强化治疗再研究[J]. .

摘要/Abstract

摘要： [摘要]目的探讨外科重症监护室(SICU)危重创伤患者应激性高血糖,不同水平目标血糖胰岛素强化治疗的有效性及安全性。方法选择2O10年1月一2O12年7月入住我院外科重症监护病房（SICU）危重创伤患者153例,且入ICU即时及30分钟血糖均〉11.1mmol/L,既往无糖尿病史(糖化血红蛋白<6%)，随机分为强化组(IIT)严格血糖控制在4.0-6.1mmol/L、优化组NICE SUGAR(NST)血糖控制在6.2-8.3mmol/L和对照组传统胰岛素治疗方案（CIT）将血糖控制在9.9-11.1mmol/l，每组各51例，收集三组患者每日胰岛素用量、低血糖、终点血糖、每日APACHEII评分、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。结果三组SICU危重创伤患者优化组(NST) 较传统胰岛素治疗方案组（CIT）有效降低ICU并发症，缩短机械通气时间及ICU时间，（P

关键词: 危重创伤, 外科重症监护病房, 应激性高血糖, 胰岛素强化治疗

Abstract: 【Abstract】　Objective　To investigate the effect and safety of intensive insulin therapy on critically trauma patients who had stress hyperglycemia, with different level goal blood glucose in surgery intensive care unit(SICU).Methods We prospectively analyzed SICU patients in 2010.1-2012.7 , whose admission blood glucose and 30 minutes blood glucose were both over 11．1mmol／L ，but without history of diabetes．Of total 153 patients were classified according to their goal blood glucose for three groups：intensive insulin therapy (IIT)group，4.0一6.1mmol/L ；NICE SUGAR(NST)group , 6．2-8．3 mmol／L, cantract insulin therapy （CIT）group was 9.9-11.1mmol/ L; each group had 51 patients. To collecting datas of three groups patients on the，the insulin doses each day, rate of hypoglycemia, final blood glucose,APACHEII scores ,time of the ventilatory support, the days of stay in ICU ,morbidity and mortality rate . Results In three groups patients, time of the ventilatory support, the days of stay in ICU ,morbidity were significantly lower in NST group than CIT group, （P

Key words: critically trauma, surgery intensive care unit, stress hyperglycemia, intensive insulin therapy