强化胰岛素治疗对急性重症胰腺炎患者的影响.docVIP

强化胰岛素治疗严格控制血糖对重症急性胰腺炎的影响 李宛霞，陶少宇 摘要：目的：探讨强化胰岛素治疗严格控制血糖对重症急性胰腺炎患者的影响。方法：将42例重症急性胰腺炎患者按入院先后分为两组：A组和B组，每组21例。两组均采用微量注射泵输入胰岛素。A组控制血糖在10.0~11.1mmoL/L，B组控制血糖在4.4~6.1mmoL/L。记录两组使用呼吸机时间、住院时间、APACHEⅡ评分及并发症等情况。结果：B组使用呼吸机时间、住院时间均明显缩短（p均0.05）,B组APACHEⅡ评分及胰腺感染发生率均显著降低（p均0.05）。结论：强化胰岛素治疗严格控制血糖能够改善重症急性胰腺炎患者预后。 关键词：胰岛素；强化；治疗；重症急性胰腺炎 中图分类号：R 文献标识码：A 文章编号： Influence of intensive insulin therapy on severe acute pancreatitis patients Liwanxia，Taoshaoyu The Emergency Department, The Second Affiliated Hospital of Nanchang University, 330006 Abstract: Objective: To investigate the effect of a tight control of blood glucose by intensive insulin therapy on patients with severe acute pancreatitis. Methods: 42 patients with severe acute pancreatitis were randomly divided into two groups: group A (maintenance of blood glucose at a level between 10.0 and 11.1 mmoL/ L) and group B (maintenance of glucose at a level between 4.4 and 6.1 mmoL/ L).Insulin were infused by micro-injection pump. Record the length of stay, APACHEⅡscore, complication and prognosis of two groups. Results: Patients receiving intensive insulin therapy were less likely to require prolonged mechanical ventilation. Patients of group B reduced the length of stay .APACHEⅡscore and incidence rate of pancreatic infection of group B were significantly decreased. Conclusion: Intensive insulin therapy contributes to the improved outcomes of patients with severe acute pancreatitis. Key words: Insulin therapy；Intensive；treatment；severe acute pancreatitis 近年来，强化胰岛素治疗在救治危重患者中日益受到了国内外学者的广泛重视。虽然存在一些争议,但多数学者认为对于危重患者用胰岛素严格控制血糖是必要的[1 ]。而重症急性胰腺炎常并发糖耐量异常、高血糖甚至酮症酸中毒，血糖控制显得尤为重要。本文探讨了强化胰岛素严格控制血糖对重症急性胰腺炎的影响，现报告如下。 1 对象与方法 1.1 临床资料： 选择2003年1月~2006年1月我科住院的重症急性胰腺炎患者42例，均符合重症急性胰腺炎诊断标准[2 ]，其中男性22例，女性20例，年龄18～76岁。有糖尿病史8例，按入院先后分入A组和B组，每组21例。 1.2 方法： 两组患者均采用微量泵输入胰岛素（南京新百药业，060402：），胰岛素50 IU加入0.9%氯化钠50 ml中控制血糖。根据VAN DEN BERGHE G胰岛素强化治疗方案[3]（见表1）调整胰岛素剂量。A组血糖控制在10.0 ~11.1mmoL/ L，B组目标血糖为4.4~6.1mmoL/ L。记录两组的住院时间、使用呼吸机时间、APACHEⅡ评分、胰腺感染发生率