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Background constantly, there is evidence that sustained hyperglycemia after severe traumatic brain injury increases the morbidity and mortality of severe traumatic brain injury patients, and patients with severe brain damage brain tissue acidosis related hyperglycemia while continuing promote the injured inflammatory cytokine release, thereby increasing the secondary brain injury. In critically ill patients, including patients with severe traumatic brain injury, although some patients with no history of diabetes, high blood sugar and insulin resistance is still very common. Studies have shown that the use of intensive insulin to control blood sugar in the normal range can improve the prognosis of these patients. The study found that to strengthen insulin therapy in critically ill surgical patients to reduce morbidity and mortality, including patients with acute traumatic brain injury. Another study on intensive insulin therapy after cardiac surgery, intensive insulin therapy to reduce complications (including infection rate) and mortality. While using intensive insulin strict control of blood sugar, increase the possibility of hypoglycemia in patients, low blood sugar will significantly inhibit the metabolism of neurons, increased neurological deficit. This makes the use of intensive insulin clinical applications for the treatment of severe traumatic brain injury is controversial. Therefore, the need for more standardized and in-depth studies to illustrate the safety and effectiveness of its application. Objective To study the safety and efficacy of severe traumatic brain injury patients Intensive insulin therapy in the neurosurgical intensive care room. Assessment to strengthen infection rate of insulin therapy to control blood sugar neurosurgical intensive care unit with severe head trauma patients, neurosurgical intensive care unit hospitalization time, the incidence of hypoglycemia, neurological outcomes and mortality. Methods randomized clinical trials, 258 hospitalized after severe traumatic brain injury (Glasgow score 3-8 points), to exclude patients dying and resuscitation invalid. The closest family members agree and sign a consent form, 202 stay in the neurosurgical intensive care units that meet the requirements of severe traumatic brain injury patients prospectively randomly divided into two groups, were treated with intensive insulin therapy and insulin treatment. To keep blood sugar levels in patients receiving intensive insulin to control blood glucose 4.4mmol / l to 6.1mmol / l. Given insulin treatment only receiving conventional treatment group patients when blood glucose level of 11.1mmol / l. Necessary, once every 1-4 hours to monitor blood glucose, for the blood glucose fluctuations larger patient, increasing the frequency of blood glucose monitoring. Intensive insulin therapy with conventional insulin therapy using a randomized trial design. Continue to accept the two groups of patients leave the neurosurgical intensive care units in the insulin infusion to keep blood sugar at normal levels. Monitoring the incidence of hypoglycemia to assess the infection rate analysis of the two groups in the neurosurgical intensive care units, neurosurgical intensive care units, hospital stay, in-hospital mortality, and mortality were followed up for 6 months, and 6 months of nerve function prognosis . Hypoglycemia in the intensive insulin therapy group and the conventional insulin therapy group, the incidence of 6 and 5, respectively, occurred in four three patients (4/103 (3.9%) vs.3/99 (3.0%) , P gt; 0.05). Receiving conventional insulin therapy in patients with infection was significantly higher than those receiving intensive insulin therapy group (44/99 (44.4%) vs.31/103 (30.1%) P lt; 0.05). The hospital stay of patients receiving intensive insulin therapy in the neurosurgical intensive care units less than the conventional insulin therapy group (the 4.1 days vs.5.5 days (median) P lt; 0.05). During the study period, two sets of in-hospital mortality similar (the tradition group of 28/99 (28.3%) vs. strengthen the group 30/103 (29.1%); P gt; 0.05). The overall mortality follow-up of 6 months, similar conventional insulin therapy group and the intensive insulin therapy group (52/96 (54.2%) vs.53/99 (53.5%), P gt; 0.05). Score higher than those receiving intensive insulin treatment group (35/99, 35.4%) were followed up for 6 months GOS (GOS = 5 and 4) the the traditional insulin group (21/96, 21.9%, P lt; 0.05). Conclusion Based on the results of this study, intensive insulin therapy neurosurgical intensive care units with severe traumatic brain injury patients is safe. Intensive insulin therapy can reduce the rate of infection of neurosurgical care units with severe traumatic brain injury patients, reduce hospitalization time of the neurosurgery intensive care units, and improve the patient's neurological outcomes, but had no significant effect on the patient's mortality.
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