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目的探讨胰岛素强化治疗对ICU无糖尿病史高血糖危重病患者预后的影响。方法选择2015年10月—2016年10月该院ICU收治的无糖尿病史高血糖危重病患者90例,以随机数字表将其均分研究组与对照组。两组患者均采取常规对症支持与胰岛素治疗。对照组血糖控制目标为9.0~11.9 mmol/L,研究组以胰岛素强化治疗方案将血糖控制目标为4.4~6.1 mmol/L。结果研究组胰岛素应用时间、抗生素应用时间、ICU入住时间均低于对照组(P<0.05)。研究组多器官功能衰竭、院内感染及死亡的发生率分别为4.44%、2.22%、2.22%,均低于对照组17.78%、17.78%、17.78%(P<0.05)。研究组低血糖的发生率17.78%,高于对照组4.44%(P<0.05)。结论胰岛素强化治疗可以有效改善ICU无糖尿病史高血糖危重病患者病情,降低并发症发生率与死亡率,保证预后效果,但其所致的低血糖问题,临床应给予足够的重视。
Objective To investigate the effect of intensive insulin therapy on the prognosis of critically ill patients with hyperglycemia without diabetes mellitus in ICU. Methods From October 2015 to October 2016, 90 cases of critically ill patients with hyperglycemia without diabetes mellitus were enrolled in this hospital. All patients were divided into study group and control group according to random number table. Both groups took routine symptomatic support and insulin therapy. In the control group, the target of glycemic control was 9.0 ~ 11.9 mmol / L. In the study group, the target of glycemic control was 4.4 ~ 6.1 mmol / L with intensive insulin therapy. Results The study group insulin application time, antibiotic application time, ICU admission time were lower than the control group (P <0.05). The incidence of multiple organ failure, nosocomial infection and death in the study group were 4.44%, 2.22% and 2.22%, respectively, which were all lower than those in the control group (17.78%, 17.78%, 17.78%, P <0.05). The incidence of hypoglycemia in the study group was 17.78%, which was higher than that in the control group (4.44%, P <0.05). CONCLUSION: Intensive insulin therapy can effectively improve the condition of critically ill patients with hyperglycemia without diabetes in ICU, reduce the complication rate and mortality, and ensure the prognosis. However, the hypoglycemia problem caused by ICU should be given enough attention in clinic.