糖尿病临床研究

　　【摘要】 目的 观察两类达标血糖控制对急危重患者预后的影响。 方法 选取2011年1月至2013年9月我院急诊重症监护室(EICU)急性生理学与慢性健康评分(APACHEⅡ)>15分且合并高血糖的危重患者200例，分为胰岛素强化治疗(IIT)组和常规控制(CIT)组，比较两组近期死亡率、3 d及7 d后APACHEⅡ评分、严重并发症、低血糖、院内感染发生率、住院天数和费用等指标。 结果 IIT组院内感染发生率、呼吸衰竭、心功能不全、3 d及7 d后APACHEⅡ评分、住院天数和费用较CIT组低(P<0.05)。IIT和CIT两组低血糖总发生率比较差异有统计学意义(P<0.01)，严重低血糖发生率比较差异无统计学意义。两组死亡率比较差异无统计学意义。 结论 IIT可能为临床带来较多益处，但增加急危重患者低血糖风险，对降低总死亡率可能无明显影响。

　　【关键词】急危重病;高血糖症;胰岛素强化治疗

　　【Abstract】 Objective To investigate the effect of two kinds of target glucose control on the prognosis of acute and critically ill patients. Methods In the emergency intensive care unit (EICU), 200 critically ill patients with hyperglycemia (APACHEⅡ score>15, random blood glucose>11.1 mmol/L) were recruited and randomized according to random blood glucose into two groups： intensive insulin therapy (IIT) group(6.1~7.8 mmol/L in insulin pump) and conventional insulin therapy (CIT) group(7.8~10.0 mmol/L in insulin pump). Recent mortality (28 days), APACHE Ⅱ score of the 3 and 7 days, severe complications, rate of hypoglycemia, Nosocomial infection, inhospital day, and inhospital costs were compared between two groups. Results The incidence of nosocomial infection, respiratory failure, heart failure, APACHE Ⅱ score of 3 and 7 days, hospitalization stays and cost were significantly lower in IIT group than in CIT group. The incidence of hypoglycemia was higher in IIT than in CIT group (29% vs 13%，P<0.01), but the difference in rates of severe hypoglycemia between two groups were not statistically significant. Mortality of IIT versus CIT groups showed no statistical significance. Conclusion IIT may bring more benefits to the clinic, but it does increase the risk of hypoglycemia in critically ill patients. At last, the total mortality rate may show no obvious influence.

　　【Key words】Acute and critically ill patients;Hyperglycemia;Intensive insulin therapy (IIT)