Coester Ariane, Neumann Cristina Rolim, Schmidt Maria Inês
Programa de Pós-graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul and Hospital de Pronto Socorro de Porto Alegre, Prefeitura Municipal de Porto Alegre, Porto Alegre, RS, Brazil.
J Trauma. 2010 Apr;68(4):904-11. doi: 10.1097/TA.0b013e3181c9afc2.
Intensive insulin therapy (IIT) has been shown to reduce morbidity and mortality in critically ill patients. Little investigation has been done to find out whether it improves the prognosis of patients with severe traumatic brain injury (STBI).
We conducted a prospective controlled study where adult patients with blunt STBI, with Glasgow Coma Scale <or=8, admitted to the intensive care unit (ICU) were randomly assigned to receive either IIT (maintenance of blood glucose between 80 mg/dL and 110 mg/dL with continuous insulin infusion) or conventional glycemic therapy (CGT) (maintenance of blood glucose below 180 mg/dL with subcutaneous insulin and insulin infusion only if blood glucose levels exceeded 220 mg/dL). The main outcome was Glasgow outcome scale 6 months after trauma. Secondary measures were hypoglycemia, incidence of infections, and days in ICU.
Of the 88 patients randomized, 42 were assigned to IIT and 46 to CGT. There was no difference (p = 0.63) in neurologic outcomes between the treatment groups: Glasgow outcome scale >3 was observed in 16 patients (41%) in the IIT and in 13 patients (32.5%) in the CGT group. More patients in the IIT group had hypoglycemia: 32 (82.1%), compared with 7 (17.5%) in the CGT group (p < 0.001). There were no differences in the number of days spent in the ICU (18.2 +/- 27.6 vs. 12.9 +/- 12.7) or in the sepsis rates (84.6% vs. 80%) between the groups.
In our study, IIT did not improve the neurologic outcome of patients with STBI but did increase the risk of hypoglycemia compared with CGT.
强化胰岛素治疗（IIT）已被证明可降低重症患者的发病率和死亡率。关于其是否能改善重型颅脑损伤（STBI）患者的预后，目前研究较少。
我们进行了一项前瞻性对照研究，将入住重症监护病房（ICU）、格拉斯哥昏迷量表评分≤8分的成年钝性STBI患者随机分为两组，分别接受IIT（持续胰岛素输注使血糖维持在80 mg/dL至110 mg/dL之间）或传统血糖治疗（CGT）（皮下注射胰岛素，仅在血糖水平超过220 mg/dL时进行胰岛素输注，使血糖维持在180 mg/dL以下）。主要结局指标为伤后6个月的格拉斯哥预后量表评分。次要指标包括低血糖、感染发生率和在ICU的住院天数。
88例随机分组的患者中，42例被分配至IIT组，46例被分配至CGT组。治疗组之间的神经学结局无差异（p = 0.63）：IIT组16例患者（41%）格拉斯哥预后量表评分>3分，CGT组13例患者（32.5%）格拉斯哥预后量表评分>3分。IIT组发生低血糖的患者更多：32例（82.1%），而CGT组为7例（17.5%）（p < 0.001）。两组在ICU的住院天数（18.2±27.6天 vs. 12.9±12.7天）或脓毒症发生率（84.6% vs. 80%）方面无差异。
在我们的研究中，与CGT相比IIT并未改善STBI患者的神经学结局，但增加了低血糖风险。
