强化胰岛素治疗策略对严重脓毒症患者预后的影响.pdfVIP

• 1210 • 中国医药2011 年 10 月第6 卷第 10 期 China Medicine. Ocωber2011. Vol. 6. No.10 ·论著· 强化膜岛素治疗策略对严重版毒症患者预后的影响 叶振海桂敬敏尤雷明张垣舜卢杰 I 摘要】 目的 研究强化膜岛素治疗方案对严重服毒症呼吸衰竭合并高血糖患者预后和并发症的影 响。方法选择严重服毒症呼吸衰竭并发高血糖症且住院跑过3 d 的患者 142 例，完全随机分为强化腕岛 素治疗组(将血糖严格控制在4.4-6.1 mmoνL) 和常规治疗组(将血糖控制在 10.0 阳 1 1. 1 mmoνL) 。观察 比较2 组 ICU 病死率、总住院病死率、ICU 住院时间和总住院时间。结果 与常规治疗组比较，强化膜岛素 治疗组的 ICU 住院夭数、总住院夭数和呼吸机治疗时间均明显缩短[ ( 12 土 3)d 比(15 士的出(l9 :l:: 6)d 比 (24 :l:: 7)d;( 10 土 2)d 比(14 主 3) d; P O. 01 ] ， ICU 病死率和总住院病死率降低[22. 5% ( 16/71 )比 42.3% (30171) ;36.6% (26/71) 比54.9% (39/71) ;P 0. 05] ，继发性肾损害减少[8.5%(6月1)比 19.7% (14/71) ; P0.05]o 结论 治疗严重服毒症合并高血糖患者时，不应考虑其既往是否有糖尿病史，而是应该应用强 化膜岛素治疗方案将血糖降至正常范围。 l 关键词1 服毒症; 膜岛素: 血糖: 病死率; 并发症 【申圄分类号] R 515. 3 【文献标识码1 A 1be clinical study of intensive insulin therapy of severe se阴is }官 Zhen-hai ， GUI Jing-min , YOU Lei-ming , ZHANG Xiωn-shun ， LU Jie. Department 01 Intensive Care Unit , First People s Hospital 01 Wuhu City , Anhui Proviru:e , Wuhu 24100日 ， China Corresponding aωhor: YE Zhen-hai.Email:yezhenghai@ [ Abstract] 0时ective To investigate the e仔ect of intensive insulin therapy on severe 四psis. Methods In a prospective ,r，四domized controlled study , adult patients who were considered to need intensive care for at least three days were enrolled. On admission , one hundred and forty-two severe sepsis patients with hyperglycemia were randomly dividided into intensive insulin therapy group (maintenance of blood glucose at a level between 4. 4 and 6.1 mmoνL) or conventional therapy group (infusion tapered when the level of glucose at a level between 10.0 and 11. 1 mmoνL). Mortality in the ICU , mortality in the hospital , days weaning from mechanical ventilation , days in 由e ICU and in the hospital , new kidney injury and new hepatic injury du