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

Yıl 2013, Cilt: 66 Sayı: 1, 33 - 44, 01.01.2013

Özlem Selvi Can Melek Tulunay Mehmet Oral Necmettin Ünal

https://doi.org/10.1501/Tipfak_0000000838

Öz

Aim: This study was planned in order to search the effect of tight blood glucose level control with continuing insulin infusion on mortality, morbidity and immune paralysis among critically ill patients. Material and Method: This prospective randomized study was conducted on 20 patients after approval from all patients or first-degree relatives were obtained on admission to intensive care unit (ICU). On admission, the patients were randomly assigned to Intensive Insulin Therapy (IIT) or Conventional Insulin Therapy (CIT) Groups. Each group involved 10 patients. In IIT Group, we tried to maintain blood glucose levels between 80-110 mg/dL via continuous insulin infusion; whereas blood glucose level was maintained between 180-200 mg/dL in CIT Group. After admission, APACHE II (Acute Physiology and Chronic Health Evaluation II) and TISS 28 (Therapeutic Intervention Scoring System) scores were calculated daily. Complete blood count, blood chemistry analyzes CRP (C-reaktive protein) levels and monocytic HLA-DR levels were determined on admission, 5th, 14th and 28th days. The length of stay in intensive care unit and in hospital were also recorded in addition to the possible cause and time of mortalities. Were performed for statistical analyzes Mann Whitney U and Chi-Square Test. The p values less than 0.05 were considered as statistically significant. Results: The tranfusion requirement, blood glucose levels at 6 a.m. and daily minimal and maximal glucose levels were found to be lower in the IIT Group (p0.05). Although intensive insulin therapy reduced intensive care unit mortality by 20% and hospital mortality by 30%, these variables were not considered to be statistically significant. In addition, this study showed that intensive insulin therapy reduced lengths of intensive care unit and hospital stay, inotropic treatment, renal replacement therapy requirement, hyperbilirubinemia and blood stream infection; however these differences were not statistically insignificant. We could not show important effect of intensive insulin therapy upon monocyte HLA-DR and CRP levels. Conclusion: There were no difference between IIT or CIT Groups in terms of mortality and immun paralysis. The tranfusion requirement, blood glucose levels at 6 a.m. and daily minimal and maximal glucose levels were significantly lower in IIT Group (p<0.05)

Anahtar Kelimeler

Criticall illness, Stress response, Hyperglycemia, İntensive insulin therapy, Tight glucose control

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

Öz

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

Anahtar Kelimeler

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

Kaynakça

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