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首页> 外文期刊>The New England journal of medicine >Intensive insulin therapy in the surgical intensive care unit.
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Intensive insulin therapy in the surgical intensive care unit.

机译：外科重症监护室的胰岛素强化治疗。

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BACKGROUND: Hyperglycemia and insulin resistance are common in critically ill patients, even if they have not previously had diabetes. Whether the normalization of blood glucose levels with insulin therapy improves the prognosis for such patients is not known. METHODS: We performed a prospective, randomized, controlled study involving adults admitted to our surgical intensive care unit who were receiving mechanical ventilation. On admission, patients were randomly assigned to receive intensive insulin therapy (maintenance of blood glucose at a level between 80 and 110 mg per deciliter [4.4 and 6.1 mmol per liter]) or conventional treatment (infusion of insulin only if the blood glucose level exceeded 215 mg per deciliter [11.9 mmol per liter] and maintenance of glucose at a level between 180 and 200 mg per deciliter [10.0 and 11.1 mmol per liter]). RESULTS: At 12 months, with a total of 1548 patients enrolled, intensive insulin therapy reduced mortality during intensive care from 8.0 percent with conventional treatment to 4.6 percent (P<0.04, with adjustment for sequential analyses). The benefit of intensive insulin therapy was attributable to its effect on mortality among patients who remained in the intensive care unit for more than five days (20.2 percent with conventional treatment, as compared with 10.6 percent with intensive insulin therapy, P=0.005). The greatest reduction in mortality involved deaths due to multiple-organ failure with a proven septic focus. Intensive insulin therapy also reduced overall in-hospital mortality by 34 percent, bloodstream infections by 46 percent, acute renal failure requiring dialysis or hemofiltration by 41 percent, the median number of red-cell transfusions by 50 percent, and critical-illness polyneuropathy by 44 percent, and patients receiving intensive therapy were less likely to require prolonged mechanical ventilation and intensive care. CONCLUSIONS: Intensive insulin therapy to maintain blood glucose at or below 110 mg per deciliter reduces morbidity and mortality among critically ill patients in the surgical intensive care unit.
机译：背景：高血糖和胰岛素抵抗在重症患者中很常见，即使他们以前没有患过糖尿病。用胰岛素治疗使血糖水平正常化是否可以改善此类患者的预后尚不清楚。方法：我们进行了一项前瞻性，随机对照研究，研究对象为接受外科重症监护室接受机械通气的成年人。入院时，患者被随机分配接受强化胰岛素治疗（维持血糖在每分升80至110 mg [4.4至6.1 mmol /升之间]）或常规治疗（仅当血糖水平超过215毫克/分升[11.9 mmol /升]，并将葡萄糖维持在180至200毫克/分升[10.0-11.1 mmol /升]之间。结果：在12个月内，总共1548例患者入组，强化胰岛素治疗将重症监护期间的死亡率从传统治疗的8.0％降低到4.6％（P <0.04，需要进行连续分析调整）。强化胰岛素治疗的益处归因于其对重症监护病房停留超过5天的患者的死亡率的影响（常规治疗为20.2％，强化胰岛素治疗为10.6％，P = 0.005）。死亡率的最大降低涉及因多器官衰竭而导致的死亡，并证明是败血症的焦点。强化胰岛素治疗还使整体住院死亡率降低了34％，血液感染减少了46％，需要透析或血液滤过的急性肾衰竭减少了41％，红细胞输注的中位数减少了50％，重症多发性神经病减少了44％接受重症治疗的患者较少需要长时间的机械通气和重症监护。结论：强化胰岛素疗法可将血糖维持在每分升110毫克或低于110毫克，可降低重症监护病房危重患者的发病率和死亡率。

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