Yoğun Bakım Hastalarında Yoğun İnsülin Tedavisi İle Kan Șekerinin Sıkı Kontrolünün Mortalite ve Morbiditeye Etkileri

Year 2008, Volume: 39 Issue: 1, 33 - 44, 20.07.2014

Ertuğrul Göksoy Özlem Selvi Can Melek Tulunay Mehmet Oral Necmettin Ünal

Abstract

Amaç: Bu çalıșma, yoğun bakım (YB) hastalarında sürekli insülin infüzyonu ile kan șekerinin sıkı kontrolünün
mortalite, morbidite ve immün paraliziye etkilerini araștırmak amacı ile planlandı.
Materyal ve Metod: Bu prospektif, randomize ve kontrollü çalıșmaya YB’a kabul edilen hasta veya birinci derece
yakınlarından onam alınan toplam 20 hasta dahil edildi. Hastalar YB’ye kabulden sonra randomize olarak, Yoğun
İnsülin Tedavisi (YİT) veya Geleneksel İnsülin Tedavisi (GİT) gruplarından birine alındı. Her iki gruba 10’ar hasta dahil
edildi. Sürekli insülin infüzyonu ile YİT grubunda kan șekeri 80-110 mg/dL, GİT grubunda 180-200 mg/dL arasında
tutuldu. Hastalar YB’ye kabul edildikten sonra günlük APACHE II (Acute Physiology and Chronic Health Evaluation II,
Akut Fizyoloji ve Kronik Sağlık Değerlendirmesi) ve TISS 28 (Therapeutic Intervention Scoring System, Tedavi Amaçlı
Girișim Skorlama Sistemi) skorlamaları yapıldı. Kabul, 5, 14 ve 28’inci günde tam kan ve biyokimyasal analizler yapıldı,
C-reaktif protein (CRP) ve akım sitometri yöntemi ile monositik HLA-DR düzeyi saptandı. Yoğun bakım ve hastanede
kalma süreleri ile olası mortalite nedeni ve zamanı kaydedildi. İstatiksel analizde Mann Whitney U Testi ve Chi-Square
Testi kullanıldı ve p

Keywords

Kritik hastalık, Stres yanıt, Hiperglisemi, Yoğun insülin tedavisi, Sıkı glukoz kontrolü

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