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目的探讨短期胰岛素强化治疗(SCIIT)对应激性高血糖患者近期临床结局的影响。方法采用随机对照临床试验,在排除影响糖代谢的疾病条件下,将120例随机血糖〉11.1mmol/L,入住ICU的重症患者随机分为短期强化治疗组(IIT组,n=60)和传统胰岛素治疗组(CIT组,n=58),治疗组在纳入研究的前7d,严格控制血糖于4.4～6.1mmol/L,此后的血糖控制及其他处理均同对照组。对照组患者的血糖控制在3.9～10mmol/L。结果入选病例120例,118例纳入研究,在停止胰岛素强化治疗20d内,治疗组平均血糖为(5.92±1.24)mmol/L,明显较对照组(9.22±2.51)mmol/L低,强化治疗后每天胰岛素用量明显比对照组低;ICU停留时间明显缩短,院内感染发生率降低,两组30d病死率无明显差异。结论采用短期胰岛素强化治疗方案可以改善重症患者的近期临床结局。
Objective To investigate the effect of short-term intensive insulin therapy (SCIIT) on the recent clinical outcome in patients with stress hyperglycemia. Methods A randomized controlled clinical trial was conducted to exclude 120 critically ill patients admitted to the ICU with short-term intensive therapy (IIT group, n = 60) and conventional In the insulin treatment group (CIT group, n = 58), the treatment group underwent strict control of blood glucose level at 4.4 to 6.1 mmol / L 7 days prior to enrollment in the study group. Thereafter, the blood glucose control and other treatments were the same as those in the control group. Control group patients with glycemic control in 3.9 ~ 10mmol / L. Results 120 cases were included in the study and 118 cases were enrolled in the study. The average blood glucose in the treatment group was (5.92 ± 1.24) mmol / L within 20 days after stopping intensive insulin treatment, which was significantly lower than that in the control group (9.22 ± 2.51) mmol / L. After intensive treatment The daily dosage of insulin was significantly lower than that of the control group. The ICU residence time was significantly shortened, and the incidence of nosocomial infection was reduced. There was no significant difference in the 30-day mortality rate between the two groups. Conclusions Short-term intensive insulin therapy may improve the near-term clinical outcome in critically ill patients.