摘要
目的比较胰岛素不同给药方式对颅脑创伤应激控制的效果。方法将107例颅脑创伤患者按随机数字列表法分为两组,微量泵入组(静脉微量泵泵入胰岛素)54例和皮下注射组(间断性皮下注射胰岛素)53例。观察并比较两组患者胰岛素用量、低血糖发生次数、血糖达标时间、机械通气时间、入住ICU时间、住院时间,治疗前后外周血多形核白细胞(PMN)、TNF-α水平以及格拉斯哥昏迷评分(GCS)、急性生理与慢性健康(APACHEⅡ)评分,以及并发症发生情况。结果与皮下注射组比较,微量泵入组患者胰岛素用量、低血糖发生次数、血糖达标时间均较低(均P<0.05),机械通气、入住ICU及住院时间均较短(均P<0.05),并发症发生率较低(P<0.05)。治疗前,两组患者PMN、TNF-α水平比较,差异均无统计学意义(均P>0.05)。治疗后,两组患者PMN水平、GCS均较治疗前上升(均P<0.05),微量泵入组PMN水平低于皮下注射组(P<0.05),而GCS高于皮下注射组(P<0.05);TNF-α水平、APACHEⅡ评分均较治疗前下降(均P<0.05),微量泵入组低于皮下注射组(均P<0.05)。结论静脉微量泵泵入胰岛素对颅脑创伤应激控制的效果优于间断性皮下注射胰岛素,值得在临床推广。
Objective To investigate the effect of administration mode on the efficacy of insulin for stress control in patients with traumatic brain injury.Methods One hundred and seven patients with traumatic brain injury were randomly assigned in study group(n=54)and the control group(n=53).In the study group the insulin was administrated with intravenous micro-pump,whereas in control group insulin was given by intermittent subcutaneous injection.The total insulin dosage,the blood glucose compliance time and the incidence of hypoglycemia were recorded and compared between the two groups.The ventilation time,the length of hospital and ICU stay were also compared.The PMN,serum TNF-αlevel were measured,the Glasgow Coma Score(GCS)and acute physiology and chronic health score(APACHE II)were assessed and the related complications were documented in two groups.Results The total amount of insulin,blood glucose compliance time and the number of hypoglycemia in the study group were significantly less than those in the control group(P<0.05).Compared with control group,the patients in study group had less mechanical ventilation time,hospital and ICU stays.Before treatment,there were no significant differences in the levels of WBC and GCS scores between the two groups(P>0.05).After treatment,the levels of PMN and GCS score increased in both groups(P<0.05),while the level of PMN in the study group was lower than that in control group,and GCS score was higher than that in control group.In addition,the levels of TNF-αand APACHE II were both decreased after treatment(P<0.05),while the levels in study group were lower than those in control group.Conclusion The curative effect of insulin administration by intravenous micro-pump is significantly better than that by intermittent subcutaneous injection for the stress control in patients with traumatic brain injury.
作者
李先如
高翔
蔺志清
LI Xianru;GAO Xiang;LIN Zhiqing(Department of Neurosurgery,Ningbo First Hospital,Ningbo 315010,China)
出处
《浙江医学》
CAS
2018年第13期1447-1450,共4页
Zhejiang Medical Journal
基金
宁波市科技计划项目(2015C50005)
关键词
颅脑创伤
应激控制
给药方式
胰岛素
Craniocerebral trauma
Stress control
Adiministration mode
Insulin
