不同血糖控制对老年危重症合并应激性高血糖患者预后的影响

摘要

目的：探讨不同血糖控制水平对老年危重症合并应激性高血糖患者近期预后的影响。方法选取2010年10月-2013年2月入住本院内科重症监护病房（ MICU）的老年危重症患者82例，将其随机分为对照组和观察组，各41例。两组均采用微量泵泵入胰岛素，对照组、观察组血糖控制目标分别为8.0～10.0 mmol/L和4.4～7.8 mmol/L。比较两组患者胰岛素用量、胰岛素使用时间、 MICU住院时间、低血糖发生率、院内感染发生率、28 d病死率、多器官功能障碍综合征（ MODS）发生率；检测两组患者入住MICU第1天和第5天血清C反应蛋白（ CRP）、白介素6（IL-6）水平。结果观察组患者胰岛素用量和低血糖发生率高于对照组，而胰岛素使用时间、 MICU住院时间、院内感染发生率低于对照组（P＜0.05）；两组患者28 d病死率及MODS发生率间无差异（P＞0.05）。入住MICU第5天观察组患者血清CRP、 IL-6水平均低于对照组（P＜0.05）。结论强化血糖控制不能降低老年危重症合并应激性高血糖患者的28 d病死率和MODS发生率，反而会增高老年危重症患者低血糖风险。%ObjectiveToexploretheeffectofdifferentlevelsofglycemiccontrolontheprognosisofoldpatientswith criticaldiseaseandstresshyperglycemia.Methods 82oldpatientswithcriticaldiseasewhoadmittedtoMICUofourhospital from October 2010 to February 2013, were randomly divided into control group and observation group , with 41 cases in each group.Insulin was pumped in both groups by a micro pump .The targets of blood glucose control were 8.0 mmol/L to 10.0 mmol/L in the control group and 4.4 mmol/L to 7.8 mmol/L in the observation group .Total dose of insulin use , duration of insulin use , and length of MICU stay , incidences of hypoglycemia and nosocomial infection , mortality on the day 28 after admission and inci-dence of multiple organ dysfunction syndrome ( MODS) were compared between two groups of patients .The levels of serum C-re-active protein (CRP) and interleukin-6 (IL-6) in two groups of patients were detected on the day 1 and day 5 after admis-sion.Results The total dose of insulin use and incidence of hypoglycemia in the observation group were significantly higher than those in the control group , while the duration of insulin use , length of MICU stay , the incidence of nosocomial infection in the observation group were significantly lower than those in the control group ( P<0.05) .There was no significant difference in mor-tality on the day 28 after admission and incidence of MODS between the two groups ( P>0.05) .The levels of serum CRP and IL-6 on the day 5 after admission in the observation group were significantly lower than those in the control group (P<0.05). Conclusion Intensive glucose control in old patients with critical disease and stress hyperglycemia can not reduce the incidence of MODS and the mortality on the day 28 after admission , but tends to increase the risk of hypoglycaemia .