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目的评价重症病治疗病人胰岛素强化治疗与传统治疗的疗效和安全性。方法收集危重重病治疗科(ICU)病人共280例,随机分为胰岛素强化治疗组142例和传统治疗组138例,并随访30d。观测胰岛素治疗人数、胰岛素剂量(U/d)、入组前和结束时(出院或转科)血糖水平、监测血糖次数频率。结果强化组和传统组的基线中年龄、男女性比、BMI、入组时血糖水平、手术人数和非手术人数比较差异无统计学意义(P>0.05)。入组治疗后器官功能障碍或衰竭人数,机械通气比,糖尿病史人数,病人死亡率,平均ICU住院时间,比较差异无统计学意义(P>0.05)。两组用胰岛素治疗的人数,胰岛素剂量(U/d),监测血糖频率差异均有显著统计学意义(P<0.01)。两级临床诊断的感染率分别为42.8%和55.5%,血培养阳性率分别6.1%和8.9%,严重低血糖发生率分别为5.6%和1.6%,比较均有显著性差异(P<0.05;P<0.01)。结论胰岛素强化治疗组与传统治疗组比较,死亡率更低,结束时血糖控制水平更低控制临床诊断的感染率和血培养阳性率更低。
Objective To evaluate the efficacy and safety of intensive insulin therapy and traditional treatment in intensive care patients. Methods A total of 280 patients with intensive care unit (ICU) were randomly divided into two groups: 142 in the intensive insulin treatment group and 138 in the conventional treatment group, and were followed up for 30 days. Insulin treatment, insulin dose (U / d), blood glucose levels before and at the end of admission (discharge or transfer) were observed, and the frequency of blood glucose was monitored. Results There were no significant differences in baseline, age, sex ratio, BMI, blood glucose level at admission, number of operatives and number of non-operative patients in the intensive and traditional groups (P> 0.05). There was no significant difference in the number of organ dysfunction or failure, mechanical ventilation ratio, the number of diabetes mellitus patients, the patient’s mortality rate, and the average ICU length of stay after treatment. There was significant difference between the two groups in the number of insulin treatment, insulin dose (U / d), monitoring blood glucose frequency (P <0.01). The infection rates of two stages of clinical diagnosis were 42.8% and 55.5% respectively, the positive rates of blood culture were 6.1% and 8.9%, and those of severe hypoglycemia were 5.6% and 1.6% respectively (P <0.05; P <0.01). Conclusions Compared with the traditional treatment group, the insulin-enhanced therapy group has lower mortality rate and lower blood glucose control level at the end of treatment, which leads to lower infection rate in clinical diagnosis and lower positive rate of blood culture.