Intensive insulin therapy after severe traumatic brain injury: A randomized clinical trial
Intensive insulin therapy after severe traumatic brain injury: A randomized clinical trial
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DOI：
10.1007/s12028-008-9084-9
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发表时间：
2008-10-01
影响因子：
3.5
通讯作者：
Rosa, Giovanni
中科院分区：
文献类型：
--
作者：
Bilotta, Federico;Caramia, Remo;Rosa, Giovanni
简介 旨在调查常规与强化胰岛素治疗的风险和可能的益处，通过低血糖事件的发生频率进行评估，低血糖事件定义为严重创伤性脑损伤 (TBI) 后入住重症监护室 (ICU) 的患者血糖浓度低于 80 mg/dl (< 4.44 mmol/l)。 方法和结果 97 名严重 TBI 后入院的患者被纳入并随机分配到两组目标血糖。当血糖水平超过 220 mg/dl (12.22 mmol/l) 时，以常规速率输注胰岛素，或以强化速率输注，以将血糖维持在 80-120 mg/dl (4.44-6.66 mmol/l)。随访期间测量了以下主要和结果变量：低血糖发作、ICU 住院时间、感染率以及使用格拉斯哥结果量表 (GOS) 测量的 6 个月死亡率和神经系统结果。接受强化胰岛素治疗的患者低血糖发作次数（定义为血糖 < 80 mg/dl 或 4.44 mmol/l）显着更高：中位（最小-最大）常规胰岛素治疗 7 次（范围 0-11）与强化胰岛素治疗 15 次（范围 6-33）； P<0.0001。接受强化胰岛素治疗的患者 ICU 停留时间较短（7.3 天 vs. 10.0 天；P < 0.05）；两组 ICU 住院期间的感染率（25.0% vs. 38.8%，P = 0.15）、6 个月时的 GOS 评分和死亡率相似。结论 强化胰岛素治疗显着增加低血糖发作的风险。尽管接受强化胰岛素治疗的患者在 ICU 停留时间较短，感染率与接受传统胰岛素治疗的患者相似，但两组患者的随访死亡率和神经系统结果相似。因此，如果要使用强化胰岛素治疗，必须尽力避免低血糖。
Introduction To investigate the risks and possible benefits of routine versus intensive insulin therapy, assessed by the frequency of hypoglycemic events defined as a glucose concentration less than 80 mg/dl (< 4.44 mmol/l) in patients admitted to the intensive care unit (ICU) after severe traumatic brain injury (TBI).Methods and Results Ninety-seven patients admitted after severe TBI, were enrolled and randomly assigned to two groups of target glycemia. Insulin was infused at conventional rates when blood glucose levels exceeded 220 mg/dl (12.22 mmol/l) or at intensive rates, to maintain glycemia at 80-120 mg/dl (4.44-6.66 mmol/l). The following primary and outcome variables were measured during follow-up: hypoglycemic episodes, duration of ICU stay, infection rate, and 6-month mortality and neurologic outcome measured using the Glasgow Outcome Scale (GOS). Episodes of hypoglycemia (defined as blood glucose < 80 mg/dl or 4.44 mmol/l) were significantly higher in patients receiving intensive insulin therapy: median (min-max) conventional insulin therapy 7 (range 0-11) vs. intensive insulin therapy 15 (range 6-33); P < 0.0001. Duration of ICU stay was shorter in patients receiving intensive insulin therapy (7.3 vs. 10.0 days; P < 0.05); while infection rates during ICU stay (25.0% vs. 38.8%, P = 0.15), and GOS scores and mortality at 6 months were similar in the two groups.Conclusions Intensive insulin therapy significantly increases the risk of hypoglycemic episodes. Even though patients receiving intensive insulin therapy have shorter ICU stays and infection rates similar to those receiving conventional insulin therapy, both groups have similar follow-up mortality and neurologic outcome. Hence if intensive insulin therapy is to be used, great effort must be taken to avoid hypoglycemia.