摘要
目的:观察胰岛素泵强化血糖控制对危重病人的预后影响。方法:选择入住急诊重症监护室(EICU)的APACHEⅡ评分>15分,同时合并高血糖(随机血糖>11.1mmol/L)的内科危重病人200例,随机分为强化胰岛素治疗(IIT)组和常规治疗(CIT)组(胰岛素泵血糖控制),观测近期死亡率(28d内)、入院72hAPACHEⅡ评分、低血糖发生率、临床感染发生率、ICU住院天数、住院费用等指标。结果:IIT组100例,CIT组100例,两组在年龄、性别构成比、疾病种类、入院血压、血糖、炎症指标、电解质、心肌酶、肝肾功能、空腹C肽、HbAlc、疾病种类、APACHEⅡ评分等指标无显著性差异(P>0.05),具有可比性。两组的治疗结局:IIT组病死率与CIT组对照无明显差异(P>0.05);IIT组院内感染发生率低于CIT组,差异有显著意义(P<0.05);IIT组低血糖发生率明显高于CIT组,差异有显著性(P<0.01),但严重低血糖发生率两组比较差异无显著意义(P>0.05);IIT组入院72hAPACHEⅡ评分、ICU住院天数、住院费用,明显低于CIT组,差异有显著性(P<0.01)。结论:IIT组与CIT组比较,虽有较高的低血糖发生率,但严重低血糖发生率无明显增高,且临床感染发生率,住院天数、住院费用更低,临床获益更大。
Objective：To investigate the effect of the intensive insulin therapy on the prognosis of critically ill patients. Method：In the emergency intensive care unit （EICU）, 200 criticalty ill patients with hyperglycemia （A PACHE Ⅱ score 〉15,random blood glucose 〉11.1 mmol/L） were recruited and randomized into two groups, with 100 subjects in the intensive insulin therapy （ⅡT） group and 100 subjects in the convention insulin therapy （CIT） group. All the subjects use insulin pump to control blood glucose. Recent mortality （28 days） ,APACHE Ⅱ scores after 72 hours from admission, rate of hypoglycemia, clinical infection rate, duration of ICU stay, and hospi-tal costs,etc, are observed. Result： There were no significant difference for patients＇ age, gender ratio, blood pres-sure, blood glucose, electrolytes, inflammatory makers, myocardial enzymes, liver and kidney functions, fasting C peptide, HbAlc, the kinds of diseases and APACHE Ⅱ score （P〉0.05） between the two groups. Results showed there was no significant difference （P〉0.05） in mortality rate between the groups. The hospital infection rate of the lit group was significantly lower than that of the CIT group （P〈0.05）. The hypoglycemia incidence rate of the ⅡT group was significantly higher than that of the CIT group （P^0.01）. But results of serious hypoglycemia showed no significant difference between the two groups. Furthermore, liT group was significantly associated with lower the 72 hours APACHE Ⅱ score,duration of ICU stay and hospital costs （P〈0.01） than the CIT group. Conclusion：Compared with the CIT group, the liT group shows higher incidence of hypoglycemia, but lower clinical infection rate, shorter hospital stay and lower inpatient cost, therefore demonstrating higher clinical benefit.
出处
《临床急诊杂志》
CAS
2013年第9期430-433,共4页
Journal of Clinical Emergency
关键词
危重病
高血糖症
胰岛素强化治疗
临床获益
critically illnesses
hyperglycemia
intensive insulin therapy
clinical benefits
