中文摘要：

目的 观察胰岛素强化治疗对重型颅脑损伤行肠外营养支持治疗患者糖脂代谢、感染情况及预后的影响，并评价其临床意义。 方法 采用随机对照研究法，将2013年9月至2014年8月四川医科大学附属第一医院神经外科住院治疗的重型颅脑损伤患者中的66例按随机数字表法分为治疗组和对照组，各33例。治疗组行胰岛素强化治疗以控制血糖水平在4.4~6.6 mmol/L，对照组患者仅血糖水平高于11.0 mmol/L时接受胰岛素皮下注射。对比治疗0、7、14 d 2组患者的糖脂代谢相关指标、院内感染率、住院时间，随访6月后对比患者格拉斯哥昏迷评分（Glasgow coma scale，GCS）。 结果 治疗0、7 d，2组患者糖脂代谢相关指标差异均无统计学意义（P〉0.05）；治疗第14天，治疗组甘油三酯浓度低于对照组，且高密度脂蛋白水平高于对照组（P〈0.05），低密度脂蛋白水平差异无统计学意义（P〉0.05）；院内感染率低于对照组（P〈0.05）；住院时间较对照组短（P〈0.05）。随访6个月后，治疗组GOS评分有优于对照组的趋势，但差异无统计学意义（P〉0.05）。 结论 胰岛素强化治疗可降低重型颅脑损伤后行肠外营养支持患者并发高血糖、高脂血症和感染的风险，改善预后。

英文摘要：

Objective To investigate the effect of intensive insulin therapy （IIT） on glucose and lipid metabolism, infection rate and prognosis in severe brain injury patients with parenteral nutrition support and evaluate the clinical significance. Methods A randomized controlled assessment was designed, and 66 hospitalized severe brain injury patients with parenteral nutrition support from September 2013 to August 2014 were randomly assigned to treatment group and control group by random number table （n=33）. The treatment group adopted IIT to maintain glucose levels at 4.4-6.6 mmol/L, and insulin was infused only when blood glucose levels exceeded 11.0 mmol/L in the control group. The outcomes including glucose and lipid metabolism indexes on 0, 7 and 14 d after treatment, incidence of nosocomial infection, hospital stays, and Glasgow outcome scale （GOS） scores after 6-month follow-up were compared. Results In 0 and 7 d, there was no significant difference in the glucose and lipid metabolism indexes between the 2 groups （P〉0.05）. On the 14 d after treatment, triglyceride concentration was relatively lower and high-density lipoprotein level was relatively higher in the treatment group （P〈0.05）, but low-density lipoprotein had no significant difference （P〉0.05）. The incidence of nosocomial infection was lower in the treatment group than the control group （P〈0.05）, and the hospital stays were shorter （P〈0.05）. The GOS scores after 6-month follow-up were similar in the 2 groups （P〉0.05）. Conclusion IIT can help the severe brain injury patients with parenteral nutrition support to reduce the incidence of hyperglycemia, hyperlipidemia and infection, and improve the outcomes.