Pilika Kliti, Roshi Enver
Anesthestesia and Intensive Care Service -Neurosurgical ICU "Mother Theresa" University Hospital Center Tirana, Albania.
Public Health Institute, Tirana, Albania.
Med Arch. 2015 Feb;69(1):46-8. doi: 10.5455/medarh.2015.69.46-48. Epub 2015 Feb 21.
Systemic Inflammatory Response Syndrome (SIRS) is a common complication in neurosurgical diseases in Intensive Care Unit (ICU). Because of associated insulin resistance (IR) the ICU is in dilemma in which stage to start the nutrition to patients and what is the amount of Insulin Unit to control the hyperglycemia.
to define the IR and to compare IR and amount of insulin among ICU patients in "Mother Theresa" University Hospital Center (MTUHC) in Tirana Albania.
154 patients with neurosurgical disease and SIRS complications were randomized in two groups: early nutrition 73 patients (47%) and late nutrition 81 (53%) and compared for a number of variables.
There was no statistical age and gender difference between the two groups (P>0.05). The amount of insulin units to control the level of glycemia (80-110 mg/dc) was 12.8±7 unit per day in early nutrition and 23.8 ±12.9 units in late nutrition group (p<0.01). No patient in early nutrition group but six (7.4%) patients in late nutrition group developed insulin resistance (p=0.03).
the IR due to the infection complications is higher among late than early nutrition group. Therefore, we suggest that in neurosurgical ICU it would be better to start the nutrition within 72 hours.
全身炎症反应综合征（SIRS）是重症监护病房（ICU）神经外科疾病的常见并发症。由于存在胰岛素抵抗（IR），ICU在决定何时开始对患者进行营养支持以及控制高血糖所需的胰岛素单位剂量方面陷入两难境地。
明确阿尔巴尼亚地拉那“特蕾莎修女”大学医院中心（MTUHC）ICU患者的胰岛素抵抗情况，并比较胰岛素抵抗及胰岛素用量。
154例患有神经外科疾病并伴有SIRS并发症的患者被随机分为两组：早期营养组73例（47%）和晚期营养组81例（53%），并对多项变量进行比较。
两组之间在年龄和性别上无统计学差异（P>0.05）。早期营养组控制血糖水平（80 - 110 mg/dc）所需的胰岛素单位剂量为每天12.8±7单位，晚期营养组为23.8±12.9单位（p<0.01）。早期营养组无患者发生胰岛素抵抗，而晚期营养组有6例（7.4%）患者发生胰岛素抵抗（p = 0.03）。
感染并发症导致的胰岛素抵抗在晚期营养组高于早期营养组。因此，我们建议在神经外科ICU，最好在72小时内开始营养支持。
