短期胰岛素强化治疗应激性高血糖临床研究.docVIP

短期胰岛素强化治疗应激性高血糖临床研究 　　【摘要】 目的 探讨短期胰岛素强化治疗(SCIIT)对应激性高血糖患者近期临床结局的影响。方法 采用随机对照临床试验,在排除影响糖代谢的疾病条件下,将120例随机血糖〉11.1 mmol/L,入住ICU的重症患者随机分为短期强化治疗组(IIT组,n=60)和传统胰岛素治疗组(CIT组,n=58),治疗组在纳入研究的前7 d,严格控制血糖于4.4～6.1 mmol/L,此后的血糖控制及其他处理均同对照组。对照组患者的血糖控制在3.9～10 mmol/L。结果 入选病例120例,118例纳入研究,在停止胰岛素强化治疗20 d内,治疗组平均血糖为(5.92±1.24)mmol/L,明显较对照组(9.22±2.51)mmol/L低,强化治疗后每天胰岛素用量明显比对照组低;ICU停留时间明显缩短,院内感染发生率降低,两组30 d病死率无明显差异。结论 采用短期胰岛素强化治疗方案可以改善重症患者的近期临床结局。 　　【关键词】 短期胰岛素强化治疗; 应激性高血糖; 重症患者 　　 　　Clinical study of short-corse intensive insulin therapy 　　 on stress-induced hyperglycemia patients 　　 　　YANG Chun-jie,SUI Xiao-chan,DU Yi-wu. 　　Endocrinology Department of First Auto Works hospital,Jilin,Changchun 130011,China 　　 　　【Abstract】 Objective To investigate the effect of short course intensive insulin therapy(SCIIT)on stress-induced hyperglycemia and outcomes in critically ill patients. Methods We excluded all the illness that may directly influenced blood glucose and the critically ill patients were maintained with normoglycemia of 4.4~6.1 mmol/L in the first seven days receivingintensive insulin therapy. Conventional insulin treatment group were maintained with blood glucose at a level between 3.9~10 mmol/L. After the first seven days,all the patients in the two groups received the same treatment as blood glucose concerned.Results Blood glucose level in IIT group(5.92±1.24 mmol/L)was lower comparing with that of the CIT group(9.22±2.51 mmol/L).Insulin consumptions in SCIIT group was also lower than that of CIP group.Patients in IIT group had significantly shorter ICU stay,lower complication rate of HAP.There was no significant difference in mortality between the two groups. Conclusion Compared with the plan of IIT,SCIIT can achieve similar blood control in critically ill patients,and improve the short-term outcomes. 　　【Key words】 Short course intensive insulin therapy; Stress-induced hyperglycemia; Critically ill 　　 　　作者单位:130011长春,一汽总医院内分泌科 　　 　　在多种应激因素的强烈刺激下,神经一内分泌系统激活和炎性介质释放过度造成