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目的探讨危重患者血糖控制水平与预后的关系。方法选择至少在ICU监护2 d且既往无糖尿病史的危重病患者144例,收住ICU时血糖水平(14.21±5.87)mmol/L,随机分为3组,均静脉泵入胰岛素控制血糖。A组48例控制血糖在4.4～6.1 mmol/L;B组48例控制血糖在6.1～8.3 mmol/L;C组48例控制血糖在8.3～11.1 mmol/L。观察3组患者使用抗生素天数、升压药和机械通气应用率,院内感染、应激性溃疡、低血糖、多脏器功能衰竭发生率,在ICU最后1 d APACHEⅡ评分、住ICU天数及病死率等参数。结果A组使用抗生素天数,升压药和机械通气需用率,院内感染、应激性溃疡和多脏器功能衰蝎发生率,在ICU最后1 d APACHEⅡ评分、住ICU天数及病死率均明显低于C组,但低血糖发生率明显高于C组(P<0.05)。A组使用抗生素天数、院内感染发生率、住ICU天数均明显低于B组,但低血糖发生率明显高于B组(P<0.05),A组其余参数与B组差异无统计学意义(P>0.05)。B组升压药与机械通气需用率,应激性溃疡、多脏器功能衰竭发生率,在ICU最后1 d APACHEⅡ评分及病死率均明显低于C组(P<0.05),B组其余参数与C组差异无统计学意义(P>0.05)。结论对于ICU危重患者强化胰岛素治疗将血糖水平控制在4.4～6.1 mmol/L可改善病情,降低病死率。
Objective To explore the relationship between the level of glycemic control and prognosis in critically ill patients. Methods At least 144 critically ill patients with no previous history of diabetes mellitus and ICU blood glucose levels of 14.21 ± 5.87 mmol / L were enrolled in this study. Patients were randomly divided into 3 groups, and all were given insulin to control blood sugar. 48 cases in group A controlled blood glucose 4.4 ~ 6.1 mmol / L; 48 cases in group B controlled blood glucose 6.1 ~ 8.3 mmol / L; 48 cases in group C controlled blood glucose 8.3 ~ 11.1 mmol / L. The days of antibiotics, vasopressor and ventilation rate, nosocomial infection, stress ulcer, hypoglycemia and multiple organ failure were observed in the three groups. APACHEⅡscore, ICU days and mortality Other parameters. Results The days of antibiotics, vasopressor and mechanical ventilation, the incidence of nosocomial infections, stress ulcer and multiple organ failure in group A were significantly lower than those in group A Lower than C group, but the incidence of hypoglycemia was significantly higher than that of C group (P <0.05). The number of antibiotics used, the incidence of nosocomial infections and the number of ICU days in group A were significantly lower than those in group B, but the incidence of hypoglycemia was significantly higher in group A than in group B (P <0.05). The remaining parameters in group A were not significantly different from those in group B P> 0.05). The rate of vasopressor and mechanical ventilation, stress ulcer and multiple organ failure in group B were significantly lower than those in group C (P <0.05) in the last 1 day of ICU There was no significant difference between parameters and C group (P> 0.05). Conclusions Intensive insulin therapy in critically ill patients with ICU will be able to improve the condition and reduce the mortality rate by controlling the blood glucose level at 4.4 ~ 6.1 mmol / L.