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目的探讨胰岛素输注方案对内科重症监护病房(MICU)患者血糖控制的作用。方法选择2007年8～10月MICU中需要进行血糖控制的患者分3个阶段进行研究,每个阶段为1个月。3个阶段分别为:①根据医生经验进行血糖控制而无目标血糖值;②根据医生经验进行目标血糖控制(4.5～7.5mmol/L);③根据计算机辅助的胰岛素输注方案进行相同目标的血糖控制。比较3个阶段每日血糖达标时间比例、每日高血糖指数(HGI)、严重低血糖次数比例。结果 3个阶段血糖达标时间比例分别为27.4、30.3、46.0,有显著性差异(P<0.001);第3阶段显著高于第1和第2阶段(P均<0.001)。3个阶段HGI分别为1.52mmol/L、1.30mmol/L、0.25mmol/L,有显著性差异(P<0.001);第3阶段HGI明显低于第1和第2阶段(P均<0.001)。3个阶段发生严重低血糖的次数比例无显著性差异(P=0.877)。结论采用计算机辅助的胰岛素输注方案能更安全、有效地控制MICU患者的血糖水平。
Objective To investigate the effect of insulin infusion on glycemic control in patients with medical intensive care unit (MICU). Methods Patients from August to October 2007 who needed blood glucose control in the MICU were studied in three phases, one for each phase. The three stages were: ① blood glucose control based on doctor’s experience without target blood glucose; ② target glucose control (4.5 ~ 7.5mmol / L) according to doctor’s experience; ③ blood glucose with the same goal according to computer-assisted insulin infusion protocol control. The proportion of daily blood glucose compliance time, daily hyperglycemia index (HGI), and severe hypoglycemia frequency were compared between the three phases. Results The time of reaching the target blood glucose level in three stages were 27.4, 30.3 and 46.0 respectively (P <0.001). The third stage was significantly higher than the first stage and the second stage (P <0.001). The levels of HGI in the three stages were 1.52mmol / L, 1.30mmol / L and 0.25mmol / L, respectively (P <0.001). The HGI in stage 3 was significantly lower than that in stage 1 and 2 (all P <0.001) . There was no significant difference in the number of severe hypoglycaemia in 3 stages (P = 0.877). Conclusions The use of computer-assisted insulin infusion regimen allows safer and more effective control of blood glucose levels in patients with MICU.