【摘要】 目的探讨不同治疗方案对ICU内应激性高血糖患者低血糖发生率的影响。方法选取我院2014年1月至2016年5月180例ICU患者。随机分为常规胰岛素治疗组(n=60)、优化胰岛素治疗组(n=60)和强化胰岛素治疗组(n=60)。观察记录各实验组患者的感染情况、机械通气时间、死亡率、低血糖发生率等。结果常规胰岛素治疗组(5.0%)和优化胰岛素治疗组(6.7%)低血糖发生率显著低于强化胰岛素组低血糖发生率(11.7%),常规胰岛素治疗组和优化胰岛素治疗组间低血糖发生率无统计学意义。死亡率、机械通气时间、感染情况优化胰岛素治疗组显著低于常规胰岛素治疗组和强化胰岛素治疗组,对比强化胰岛素治疗组和常规胰岛素治疗组间死亡率、机械通气时间、感染情况差异无统计学意义。优化胰岛素治疗组(15.0%)和强化胰岛素治疗组(13.3%)感染情况显著低于常规胰岛素治疗组(21.6%),优化胰岛素治疗组和强化胰岛素治疗组间感染情况无统计学意义。结论优化胰岛素治疗在减少危重患者的感染同时能有效降低低血糖发生率,对改善临床疗效降低死亡率效果明显。更多还原

【Abstract】 Objective To investigate the effect of different treatment strategies on patients who had stress hyperglycemia induced by critical trauma,when different blood glucose was aimed in intensive care unit(ICU).Methods We retrospectively analyzed ICU patients who were admitted between 2014.1-2016.5 with admission blood glucose over 11.2mmol/L.Without known history of diabetes,without known history of take hormone.In total,180 patients were randomly divided set into three groups according to their target blood glucose:conventional in Sulin therapy group with target blood glucose of 10.0~11.1mmol/L(n=60);NICE SUGAR group with target blood glucose of 6.1~8.4mmol/L(n=60);intensive insulin therapy group with target blood glucose of 4.5~6.0 mmol/L(n=60).To collect data from these three groups of patients,we compared hypoglycemia incidence,time of the ventilatory support,infection rate,morbidity and mortality rate.Results Comparing these three groups,hypoglycemia incidence,was significantly lower in conventional in Sulin therapy group and NICE SUGAR group than in intensive insulin therapy group,no significant difference of hypoglycemia incidence was shown between conventional in Sulin therapy group and NICE SUGAR group.Ventilation time was shortest in NICE SUGAR group but show no significant difference between conventional in Sulin therapy group and intensive insulin therapy group.Comparing these three groups,infection rate,was significantly lower in NICE SUGAR group and intensive insulin therapy group than in conventional in Sulin therapy group,no significant difference of infection rate was shown between NICE SUGAR group and intensive insulin therapy group.Compared with intensive insulin therapy group and conventional in Sulin therapy group,the mortality rate was significantly higher than in NICE SUGAR group.Conclusion Intensive insulin therapy and keeping blood glucose at 6.1~8.4mmol/L by NICE SUGAR can reduce the mortality,infection rate and hypoglycemia incidence for the critically ill patients with stress hyperglycemia.更多还原