摘要
目的探讨应激性高血糖(SHG)对ICU危重症患者心功能的影响及给予强化胰岛素治疗的效果。方法对2010年12月—2014年9月解放军254医院收治的80例非糖尿病危重症患者入院即刻监测血糖,按血糖值分为SHG组(56例)和血糖正常组(24例),将SHG组随机分为常规治疗组(28例)和强化组(28例)。比较SHG及血糖正常者入院时心功能、住院情况及预后;并观察常规治疗组和强化组治疗前后心功能改善情况。结果 SHG组右房压(RAP)、肺动脉压(PAP)、肺动脉楔压(PAWP)、脑利钠肽(BNP)明显高于血糖正常组,心排血量(CO)、心脏指数(CI)、氧分压(Pa O2)和二氧化碳分压(Pa CO2)低于血糖正常组(P<0.05)。强化组治疗后RAP、PAP、PAWP、BNP低于治疗前和对照组,CO、CI、Pa O2、Pa CO2高于治疗前和对照组(P<0.05)。SHG患者ICU住院天数、应用呼吸机人数、机械通气时间和病死率均较血糖正常组增加,但强化组较常规治疗组降低(P<0.05)。结论 SHG对危重症患者的心功能有明显影响,给予胰岛素强化治疗可明显改善心功能。
Objective To investigate the effect of stress hyperglycemia（ SHG） on cardiac function and effectiveness of insulin intensive therapy for critical patients in ICU. Methods A total of 80 critical non-diabetic patients admitted to ICU were recruited in this study,and blood sugar levels were detected immediately after admission. The patients were divided into SHG patients（ n = 56） and the euglycemia group（ n = 24） according to detection results,and the SHG patients were randomly divided into the routine treatment subgroup（ n = 28） and the intensive treatment subgroup（ n =28）. Cardiac function,hospitalization condition and prognosis in the two groups were compared upon admission,and the improvement of cardiac function between and after the routine and the intensive treatments was observed. Results In SHG group,the levels of right atrial pressure（ RAP）,pulmonary arterial pressure（ PAP）,pulmonary arterial wedge pressure（ PAWP） and brain natriuretic peptide（ BNP） were significantly higher,while the levels of cardiac output（ CO）,cardiac index（ CI）,partial pressure of oxygen（ Pa O2） and partial pressure of carbondioxide（ Pa CO2） were significantly lower than those in the euglycemia group. In the intensive treatment subgroup,the levels of RAP,PAP,PAWP and BNP were significantly lower,while the levels of CO,CI,Pa O2 and Pa CO2 were significantly higher than those before the treatment and in the routine treatment subgroup（ P 0. 05）. In the SHG group,the hospital days,total number of patients using mechanical ventilation,the time of mechanical ventilation and mortality rate were increased,compared with those in the euglycemia group,while the indexes in the intensive treatment subgroup were significantly decreased,compared with those in the routine treatment subgroup（ P 0. 05）. Conclusion The SHG can obviously affect the cardiac function of patients in ICU,and insulin intensive therapy can markedly improve the cardiac function.
出处
《解放军医药杂志》
CAS
2015年第10期47-51,共5页
Medical & Pharmaceutical Journal of Chinese People’s Liberation Army
关键词
应激性高血糖
危重病
心功能
胰岛素
Stress hyperglycemia
Critical illness
Cardiac function
Insulin
