【摘要】 目的 探索脓毒症并发高血糖时血糖控制的方法 。方法 收集2011年3月~2014年2月湖南省儿童医院急救中心157例并发高血糖的脓毒症患儿,按入院时血糖分组。第1组:血糖≥15mmol/L时,限糖,静脉注射胰岛素0.1U/kg,每隔2 h测血糖;第2组:当10≤血糖<15 mmol/L,皮下注射胰岛素0.1U/kg,限制外源性高浓度葡萄糖输注(仅用5%葡萄糖),每输注葡萄糖6 g,加胰岛素IU皮下注射,间隔2 h测血糖;第3组:当7.0≤血糖<10mmol/L,每输注葡萄糖6 g,加胰岛素1U皮下注射。主要观察指标为危重病例评分、血糖水平、胰岛素使用前后血糖波动范围、胰岛素、C肽、HOMA-IR和HOMA-β等。结果 3组患儿血糖均呈下降趋势;3组比较,危重病例评分(PCIS)PCIS、C肽、PH值、血乳酸、PCT、HOMA-IR、HOMA-β、第1天和第3天血糖、血糖波动值差异有统计学意义(P<0.01或0.05);胰岛素治疗后,112例患儿血糖呈下降趋势,45例患儿血糖上升或反复,有7例发生不同程度低血糖,但仅1例患儿血糖低于2.2mmol/L。结论 在监测同时,按高血糖程度采用上述限糖和小剂量胰岛素治疗方案安全有效。更多还原

【Abstract】 Objective To observe the safety and effct of insulin application in children of sepsis complicated with hyperglycemia.Methods 157 children of sepsis complicated with hyperglycemia,97 boys and 60 girls,aged 1 month-10 years and 1 month,were divided into 3 groups according to their blood glucose(BG)on admission:Group 1 with the BG ^15 mmol/L that was to receive insulin 0.1 U/kg,I.V.and undergo BG examination every 2 hours,Group 2 with(10 mmol/L^BG<15 mmol/L) receiving subcutaneous injection of insulin 0.1 U/kg and insulin 1 U in addition for every 6g glucose in 5%glucose injection,and undergo BG examination every 2 hours;and Group 3(7.0 mmol/L^BG<10 mmol/L).that received subcutaneous injection of I U insulin for each infusion of 6g glucose.The levels of pediatric clinical Illness score(PCIS),BG,insulin,peptide C,and lactic acid were measured for 3 days.HOMA-IR and HOMA-B were calculated.Results The glucose levels declined in these 3 groups.,the PCIS,eptide C,PH,lactate,PCT,HOMA-IR,HOMA-B,the blood glucose at the first day and the third day,and blood glucose fluctuation were different among the three groups(P <0.01 or 0.05).After use of insulin,the BG levels decreased in 112 patients,increased of fluctuated in45 patients.There were not significant differences in other parameters among these 3 griuos.were increase or wave,7 patients were hypoglycemia,and only 1 patients’ blood glucose less than 2.2mmol/l.Conclusions While monitoring the levels of blood glucose,the methods of limiting sugar and low dosage insulin were effective to sepsis patients with hyperglycemia.更多还原