目的：探讨应用强化胰岛素模式治疗不同血糖控制水平对内科脓毒症患者的影响。方法：按随机原则，符合条件的病例分成强化胰岛素治疗A组和强化胰岛素治疗B组，A组32例，B组33例。 A组血糖控制在4.4～6.1mmol/L，B组血糖控制在6.1～8.3mmol/L。对两组患者的ICU住院天数、ICU住院医疗费用、总住院天数、病死率、MODS发生率、低血糖发生率，治疗前及治疗后第五天血清CRP水平变化进行比较。结果：两组患者入重症医学科时在平均年龄、性别比例和APACH II评分上相似（P>0.05），具有可比性。两组在ICU住院时间、ICU住院费用和总住院时间差异均无统计学意义（P>0.05）。A组MODS发病率、低血糖发生率和病死率明显低于B组，差别有统计学意义（P<0.05）。两组患者治疗后的CRP水平比治疗前均有显著下降，差异有统计学意义（P<0．05）。两组患者之间比较，治疗前CRP水平无明显差异（P>0.05），治疗后A组患者CRP水平比B组患者低，有显著差异（P<0．05）。结论：对于脓毒症进行强化胰岛素治疗可以减轻炎症反应，且将血糖严格控制在4.4～6.1mmol/L水平比将血糖控制在较高水平6.1～8.3mmol/L，MODS的发病率明显降低，但同时要注意严密监测血糖，以避免低血糖给患者带来危害。%Objective :To investigate the effects of intensive insulin therapy in different levels of blood glucose control in patients with sepsis of medicine. Methods: The patients who meet the conditions of intensive insulin therapy were randomly divided into group A and B. There were 32 people in group A and 33 people in group B. The days in the ICU,ICU hospitalization expenses,The total days in hospital, mortality,the incidence of MODS and hypoglycemia,serum C—reactive protein before and after treatment were compared. Results:The average age, sex ratio and APACH II scores in two groups were similar (P>0.05).In addition, the days in the ICU , ICU hospitalization expenses and the total days in hospital were not statistically different (P>0.05).The CRP levels after treatment in both groups were significantly lower than that before treatment (P<0.05). However, after treatment, the CRP level of group A was lower than that of group B (P<0.05).Conclusions: For patients with sepsis, intensive insulin therapy can reduce inflammation, and it is more obvious in the blood glucose level of 4.4~6.1mmol/L than that of 6.1~8.3mmol/L.Strict control of blood glucose level in 4.4~6.1mmol/L, the incidence of MODS can be significantly reduced. Meanwhile, we should pay attention to monitor blood sugar in order to avoid the harm of hypoglycemia.
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