Safety and Efficacy of Intensive Insulin Therapy in Critical Neurosurgical Patients
Safety and Efficacy of Intensive Insulin Therapy in Critical Neurosurgical Patients
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DOI：
10.1097/aln.0b013e318198004b
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发表时间：
2009-03-01
期刊：
影响因子：
8.8
通讯作者：
Rosa, Giovanni
中科院分区：
文献类型：
--
作者：
Bilotta, Federico;Caramia, Remo;Rosa, Giovanni
背景：将血糖维持在6.11 mM或以下的强化胰岛素治疗可降低心脏手术后的发病率和死亡率以及内科重症监护病房(ICU)患者的发病率。作者对神经外科手术后接受强化胰岛素治疗与常规胰岛素治疗的临床安全性和结局进行了比较。方法：在这项前瞻性随机对照试验中，483名接受择期或急诊脑外科手术的患者被随机分为强化胰岛素治疗组(241例)和常规胰岛素治疗组(242例)，前者接受胰岛素治疗以维持血糖水平在4.44-6.11 mM之间，后者接受胰岛素治疗以维持血糖水平在11.94 mM以下。主要终点是低血糖发生率(定义为血糖2.78 mm)。疗效指标包括ICU住院时间、感染率、6个月随访格拉斯哥预后量表评分和总存活率。结果：接受强化胰岛素治疗的患者发生低血糖事件的频率更高，中位数(最小-最大值)：8(0-23)比3(0-4)；P<；0.0001。ICU住院天数较短(6天比8天，P=0.0001)，感染率较低(25.7%比39.3%，P=0.0018)。两组患者格拉斯哥预后评分和6个月总生存期相似。结论：颅脑手术后住神经外科ICU的患者强化胰岛素治疗与医源性低血糖有关，但也能减少感染率，缩短ICU住院时间。
Background: Intensive insulin therapy to maintain blood glucose at or below 6.11 mM reduces morbidity and mortality after cardiac surgery and morbidity in medical intensive care unit (ICU) patients. The authors investigated the clinical safety and outcome effects of intensive insulin therapy compared to conventional insulin therapy in patients receiving postoperative intensive care after neurosurgical procedures.Methods: In this prospective randomized controlled trial, 483 patients undergoing elective or emergency brain surgery were prospectively and randomly assigned either to intensive insulin therapy (241 patients), receiving insulin titrated to maintain blood glucose levels within the range of 4.44-6.11 mM, or to conventional insulin therapy (242 patients), receiving insulin to maintain blood glucose levels below 11.94 mM. Primary end-point was incidence of hypoglycemia (defined as blood glucose < 2.78 mM). Efficacy measures included the length of ICU stay, infection rate, and 6 months follow-tip Glasgow outcome scale score and overall survival.Results: Hypoglycemia episodes were more frequent in patients receiving intensive insulin therapy, median (min-max): 8 (0-23) versus 3 (0-4); P < 0.0001. The length of stay in the ICU was shorter (6 vs. 8 days; P = 0.0001), and the infection rate was lower (25.7% vs. 39.3%; P = 0.0018). Glasgow outcome scale score and overall survival at 6 months were similar in the two groups.Conclusions: Intensive insulin therapy in patients admitted to a postoperative neurosurgical ICU after brain surgery is associated with iatrogenic hypoglycemia, but it can also reduce the infection rate and shorten the ICU stay.