Insulin Therapy By Intravenous Pump In Critical Illness

PurposeBy comparative experiment, to observe the clinical curative effects of computer-based insulin intravenous infusion in the treatment of stress hyperglycemia in the critically ill patients. Made multiple comparisons with the computer-based insulin infusion in treatment group and the multiple subcutaneous insulin injection in the control group in the average recovering time of blood glucose,the average total dosage of insulin, the incidence of hypoglycemia, serum levels of Na+、K+、Ca2+、Cl-concentration, the days in ICU, the days in hospital altogether, the duration time of ventilation, the incidence of hospital infection, the incidence of sepsis, the incidence of multiple organ dysfunction syndrome and mortality to observe the clinical curative effects of computer-based insulin intravenous infusion in the treatment of stress hyperglycemia.MethodRandom control research was adopted and129eligible patients in ICU were randomly divided into an experimental group(computer-based insulin intravenous infusion group)and a control one(multiple subcutaneous insulin injection group).The group of computer-based insulin intravenous infusion including65cases and the group of multiple subcutaneous insulin injection including64cases respectively;The group of computer-based insulin intravenous infusion:by computer-based insulin intravenous infusion to treat stress hyperglycemia, and adjusted the pumping speed of computer-based insulin intravenous infusion according to blood glucose;The group of multiple subcutaneous insulin injection: by multiple subcutaneous insulin injection to treat stress hyperglycemia, and adjusted the dosage of subcutaneous insulin injection according to blood glucose;Made multiple comparisons with the computer-based insulin infusion in treatment group and the multiple subcutaneous insulin injection in the control group treatment in the average recovering time of blood glucose,the average total dosage of insulin, the incidence of hypoglycemia, serum levels of Na+、K+、Ca2+、Cl-concentration at the start and end of the trial, the days in ICU, he days in hospital altogether, the duration time of ventilation, the incidence of hospital infection, the incidence of sepsis, the incidence of multiple organ dysfunction syndrome and mortality respectively.ResultThere was no statistical differences in general data, such as the age, sex, fasting blood glucose, random blood glucose, APACHE-Ⅱ scores, weight and serum levels of Na+、K+、Ca2+Cl-concentration at the start of the trial;Made a comparison in the average recovering time of blood glucose, the computer-based insulin infusion in treatment group was shorter than that of the multiple subcutaneous insulin injection in control group:[(8.2±2.4) VS (18.4±6.3)] hours, P<0.05.there was a significant statistical difference.Made a comparison in the average total dosage of insulin, the computer-based insulin infusion in treatment group was less than that of the multiple subcutaneous insulin injection in control group:[(0.89±0.27) VS (1.28±0.32)]u/kg.d, P<0.05,there was a significant statistical difference.Made a comparison in the incidence of hypoglycemia, the computer-based insulin infusion in treatment group was less than that of the multiple subcutaneous insulin injection in control group:[(0.24±0.07) VS (0.76±0.18)] times every patient, P<0.05,there was a significant statistical difference.The computer-based insulin infusion in treatment group: the incidence of hospital infection was6.4%,the incidence of sepsis was34.2%,the incidence of multiple organ dysfunction syndrome was25.7%,mortality was5.3%; the multiple subcutaneous insulin injection in control group: the incidence of hospital infection was18.6%,the incidence of sepsis was58.3%,the incidence of multiple organ dysfunction syndrome(MODS) was42.6%,mortality was13.1%; the incidence of hospital infection, the incidence of sepsis, the incidence of multiple organ dysfunction syndrome and mortality of the computer-based insulin infusion in treatment group were lower than those of the multiple subcutaneous insulin injection in control group, P<0.05,there were significant statistical differences.Made multiple comparisons in the days in ICU, the days in hospital altogether, the duration time of ventilation with the computer-based insulin infusion in treatment group and the multiple subcutaneous insulin injection in control group. the days in ICU, the days in hospital altogether, the duration time of ventilation of the computer-based insulin infusion in treatment group were shorter than those of the multiple subcutaneous insulin injection in control group: the duration time of ventilation[(15.7±2.9) VS (42.4±8.6)] hours; the days in ICU[(2.7±0.9) VS (9.2±2.7)] days; the days in hospital altogether[(9.4±2.6) VS (23.6±4.3)] days, P<0.05,there were significant statistical differences.Compared with the multiple subcutaneous insulin injection in control group, the range of K+concentration decreased and Ca2+concentration increased of the computer-based insulin infusion in treatment group were more significant,[(3.62±0.16)VS (4.29±0.27)] mmol/1、[(2.53±0.22),VS (2.16±0.11)] mmol/1,P<0.05, there were significant statistical differences.ConclusionComputer-based insulin intravenous infusion in the treatment of Stress hyperglycemia in the critically ill patients,which could lower the rate of hypoglycemic episodes, manage blood glucose level smoothly and effectively, correct the metabolic disorder, shorten the average recovering time of blood glucose, decrease the days in ICU, the days in hospital altogether and the total insulin dosage,relieved the economic burden of patients to a certain extent, however, decreased the incidence of infection, multiple organ dysfunction syndrome(MODS) and mortality. Therefore computer-based insulin infusion protocol is a convenient, easy, economic, efficient, safe, reliable treatment method.