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目的探讨甘精胰岛素控制全身炎症反应综合征(SIRS)患者应激性高血糖的效果。方法对无糖尿病史的SIRS患者,采用前瞻性研究方法,在开通静脉通道前采集静脉血监测血糖,血糖值>11.0mmol/L患者,采用连续静脉输注胰岛素控制血糖48h,然后随机分成两组:治疗组(142例)先计算出前24h静脉输注胰胰素总量,然后将总量的50%作为基础胰岛素用量,即甘精胰岛素用量,夜间皮下注射1次/d;每餐前加速效胰岛素0.05U/kg,根据血糖情况每1～2d调整胰岛素用量。对照组(145例)同样先计算出前24h静脉输注胰岛素总量,然后根据总量分配三餐前速效胰岛素用量,联合睡前使用中性鱼精蛋白锌胰岛素,根据血糖情况每1～2d调整胰岛素用量。每2～4h监测血糖1次。结果治疗组血糖达标时间、治疗后平均血糖均优于对照组,差异有统计学意义(P<0.05);治疗组每天胰岛素用量低于对照组,差异有统计学意义(P<0.05);治疗组夜间低血糖发生率低于对照组(P<0.01)。结论对于SIRS发生应激性血糖升高患者,甘精胰岛素配合三餐前速效胰岛素治疗能更及时、有效、安全地控制血糖。
Objective To investigate the effect of insulin glargine on stress hyperglycemia in patients with systemic inflammatory response syndrome (SIRS). Methods SIRS patients without a history of diabetes mellitus were enrolled in this study. A prospective study was conducted to collect blood samples of venous blood before the opening of the venous channel to monitor the blood glucose. Patients with blood glucose> 11.0 mmol / L were treated with continuous intravenous infusion of insulin for 48 hours and then randomly divided into two groups : The treatment group (142 cases) first calculated the first 24 hours of intravenous infusion of pancreatic insulin total amount, and then the total amount of 50% as the basal insulin dosage, that is, the amount of insulin glargine, subcutaneous injection at night 1 / d; before each meal accelerated Effective insulin 0.05U / kg, according to the blood glucose every 1 ~ 2d adjust the amount of insulin. Control group (145 cases) also calculated the first 24 hours before intravenous infusion of total insulin, and then allocated according to the total amount of fasting insulin before meals, combined with bedtime neutral protamine zinc insulin, according to the blood glucose every 1 ~ 2d adjustment Insulin dosage. Every 2 ~ 4h blood glucose monitoring 1 times. Results The mean blood glucose of the treatment group was significantly higher than that of the control group after treatment (P <0.05). The daily insulin dosage of the treatment group was lower than that of the control group (P <0.05) Group night hypoglycemia incidence was lower than the control group (P <0.01). Conclusion In patients with stress-induced hyperglycemia in SIRS, insulin glargine and pre-meal fast-acting insulin therapy can control blood sugar more promptly, effectively and safely.