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目的探讨不同血糖控制水平对外科重症患者炎症反应及预后的影响。方法将188例术后入加强治疗病房(ICU)的 APACH Ⅱ>10分的重症患者随机分为血糖严格控制组(4.4～6.1mmol/L,n=75)、控制组(6.7～8.3 mmoL/L,n=75)和对照组(10.0～11.1 mmol/L,n=38)。使用计算机程序化血糖管理方案控制血糖至目标水平,记录各组术后第1、4、7天血清 C 反应蛋白(CRP),呼吸机使用天数、感染发生率、术后红细胞输注量、住 ICU 费用、住 ICU 天数、住院病死率等。结果两血糖控制组红细胞输注及感染发生率均低于对照组(P<0.05)。与对照组相比,严格控制组呼吸机使用天数及住 ICU 天数明显缩短(P<0.05)。在住院病死率、住 ICU 费用方而,严格控制组与其他两组比较,亦有降低(P>0.05)。低血糖发生率(<3.3 mmol/L),严格控制组仍明显高于其他两组(P<0.05)。结论应激后控制血糖于正常可能更有利于改善外科重症患者预后,减少住 ICU 天数与费用。对于确定最佳的目标血糖,还需进一步的相关研究。
Objective To investigate the effects of different blood glucose levels on the inflammatory response and prognosis of critically ill surgical patients. Methods A total of 188 critically ill patients admitted to Intensive Care Unit (ICU) with APACH Ⅱ> 10 were randomly divided into control group (4.4-6.1 mmol / L, n = 75), control group (6.7-8.3 mmoL / L, n = 75) and control group (10.0-11.1 mmol / L, n = 38). Blood glucose was controlled to the target level by computerized program of glycemic control. Serum C-reactive protein (CRP), days of ventilator use, incidence of infection, amount of red blood cell transfusion, ICU costs, ICU days, in-patient mortality and more. Results The incidences of erythrocyte transfusion and infection in the two blood glucose control groups were lower than those in the control group (P <0.05). Compared with the control group, the number of days of ventilator use and days of ICU stay in strictly controlled group were significantly shortened (P <0.05). In-hospital mortality, ICU cost side, while the strict control group compared with the other two groups, also decreased (P> 0.05). The incidence of hypoglycemia (<3.3 mmol / L) was significantly higher in the severe control group than in the other two groups (P <0.05). CONCLUSIONS: Controlling blood glucose after stress may be more beneficial to improve the prognosis of severe critically ill patients and reduce the number of ICU days and costs. For determining the best target glucose, further research is needed.