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目的探讨重型症颅脑损伤(TBI)患者合理的血糖(BG)控制目标。方法应激性高血糖TBI患者217例,随机分为两组:A组113例,目标BG水平8.3-10.1mmol/L;B组104例,目标BG水平4.4-6.1mmol/L。从入组开始至第7天,采用持续静脉泵入胰岛素实施BG目标管理。记录BG、低BG发生率、日平均胰岛素用量和3个月后格拉斯哥预后评分(GOS)。结果治疗期,A组BG高于B组[(10.73±2.86)mmol/L vs.(6.31±3.46)mmol/L](P<0.01),低BG发生率(0.86%vs.2.87%)、日平均胰岛素用量[(35.14±11.36)U vs.(58.56±14.53)U]均低于B组(P<0.01)。两组3个月后GOS评分相仿。结论强化胰岛素治疗并不能改善TBI患者预后。
Objective To investigate the reasonable control of blood glucose (BG) in patients with severe traumatic brain injury (TBI). Methods 217 stress hyperglycemia patients with TBI were randomly divided into two groups: A group of 113 patients, the target BG level of 8.3-10.1mmol / L; B group of 104 patients, the target BG level of 4.4-6.1mmol / L. From the start of the study to the seventh day, BG was administered by continuous intravenous infusion of insulin. BG, low BG incidence, daily mean insulin dose, and Glasgow Outcome Score (GOS) after 3 months were recorded. Results During the treatment period, BG in A group was significantly higher than that in B group [(10.73 ± 2.86) mmol / L vs. (6.31 ± 3.46) mmol / L], and the incidence of low BG was 0.86% vs 2.87% The average daily insulin dosage [(35.14 ± 11.36) U vs. (58.56 ± 14.53) U] was lower than that of group B (P <0.01). GOS scores were similar between the two groups after 3 months. Conclusion Intensive insulin therapy does not improve the prognosis of patients with TBI.