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目的观察胰岛素强化治疗对重型颅脑损伤行肠外营养支持治疗患者糖脂代谢、感染情况及预后的影响,并评价其临床意义。方法采用随机对照研究法,将2013年9月至2014年8月四川医科大学附属第一医院神经外科住院治疗的重型颅脑损伤患者中的66例按随机数字表法分为治疗组和对照组,各33例。治疗组行胰岛素强化治疗以控制血糖水平在4.4~6.6 mmol/L,对照组患者仅血糖水平高于11.0 mmol/L时接受胰岛素皮下注射。对比治疗0、7、14 d 2组患者的糖脂代谢相关指标、院内感染率、住院时间,随访6月后对比患者格拉斯哥昏迷评分(Glasgow coma scale,GCS)。结果治疗0、7 d,2组患者糖脂代谢相关指标差异均无统计学意义(P>0.05);治疗第14天,治疗组甘油三酯浓度低于对照组,且高密度脂蛋白水平高于对照组(P<0.05),低密度脂蛋白水平差异无统计学意义(P>0.05);院内感染率低于对照组(P<0.05);住院时间较对照组短(P<0.05)。随访6个月后,治疗组GOS评分有优于对照组的趋势,但差异无统计学意义(P>0.05)。结论胰岛素强化治疗可降低重型颅脑损伤后行肠外营养支持患者并发高血糖、高脂血症和感染的风险,改善预后。
Objective To observe the effect of intensive insulin therapy on glucose and lipid metabolism, infection and prognosis in patients with severe craniocerebral injury treated with parenteral nutrition and to evaluate its clinical significance. Methods A randomized controlled study was used to divide 66 patients with severe craniocerebral injury hospitalized in Department of Neurosurgery, First Affiliated Hospital of Sichuan Medical University from September 2013 to August 2014 according to the random number table, and divided into treatment group and control group , 33 cases in each. The treatment group underwent intensive insulin therapy to control blood glucose levels at 4.4 to 6.6 mmol / L, while patients in the control group received insulin subcutaneous injection only when blood glucose levels were above 11.0 mmol / L. The indexes of glucose and lipid metabolism, nosocomial infection rate and length of hospital stay were compared between two groups at 0, 7, and 14 days. The Glasgow coma scale (GCS) was compared between the two groups after 6 months of follow-up. Results There was no significant difference in the index of glucose and lipid metabolism between the two groups on the 0 and 7 d treatment (P> 0.05). On the 14th day of treatment, the triglyceride concentration of the treatment group was lower than that of the control group, and the level of high density lipoprotein Compared with the control group (P <0.05), the level of LDL was no significant difference (P> 0.05). The infection rate in the hospital was lower than that in the control group (P <0.05). The hospital stay was shorter than that in the control group (P <0.05). After 6 months of follow-up, the GOS score of the treatment group was superior to that of the control group, but the difference was not statistically significant (P> 0.05). Conclusion Intensive insulin therapy can reduce the risk of hyperglycemia, hyperlipidemia and infection in patients with parenteral nutrition support after severe brain injury and improve the prognosis.