Rediscovery the Effect of Intensive Insulin Therapy on Stress Hyperglycemia in Critical Trauma Patients / 天津医药

ABSTRACT

Objective To investigate the effect and safety of intensive insulin therapy on patients who had stress hy-perglycemia induced by critical trauma, when different blood glucose was aimed in surgery intensive care unit (SICU). Methods We retrospectively analyzed SICU patients who were admitted between 2010.1-2012.7 with admission blood glucose and 30 minutes blood glucose both over 11.1 mmol/L ,and without known history of diabetes. In total, 153 pa-tients were set into three groups according to their target blood glucoseintensive insulin therapy (IIT) group with target blood glucose of 4.0-6.1 mmol/L;NICE SUGAR (NST) group with target blood glucose of 6.2-8.3 mmol/L;conventional in-sulin therapy(CIT)group with target blood glucose of 9.9-11.1 mmol/L. Each group had 51 patients. To collect data from these three groups of patients,we compared daily insulin doses , hypoglycemia incidence, final blood glucose, APACHEⅡscores upon discharging from ICU, time of the ventilatory support, length of staying in ICU, morbidity and mortality rate. Results Comparing these three groups, daily insulin dosage and hypoglycemia incidence, were significantly lower in NST and CIT group than in IIT group. Daily insulin dosage was higher in NST group than in CIT group;no significant difference of hypoglycemia incidence was shown between NST group and CIT group. The final blood glucose was lowest in IIT group and highest in CIT group (P＜0.05). APACHE II score was 9.3±7.5 upon discharge from ICU in NST group. Ventilation time and duration of ICU admission both were shortest in NST group but show no significant difference between IIT and CIT group . No significant difference of complicate incidence and mortality rate was indicated among all three groups. Conclusion In patient with stress hyperglycemia induced by critical trauma,maintaining the patients’final blood glucose between 6.2-8.3 mmol/L can effectively control the stress hyperglycemia,improve prognosis and reduce the mortality of hypoglycemia.