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目的观察强化胰岛素治疗对严重多发伤患者预后的影响。方法选择2006年6月至2009年6月大连大学附属中山医院外科ICU所收治的严重多发伤患者62例,近期严重疾病史,ISS>16分者且伤及两个以上解剖部位的患者,将其随机分成两组:强化胰岛素治疗组(n=31),常规治疗组(n=31)。强化胰岛素治疗组入院后即上胰岛素泵控制血糖在4.0～6.1mol/L,常规治疗组血糖控制在10.0～11.0mol/L。观察两组患者治疗后血液TNF-a、IL-I、IL-6、CRP的变化以及APACHEⅡ评分的变化、治愈率。统计数据以均数±标准差(χ—±s)表示,经SPSS10.0软件用成组t检验及单因素方差分析,以P<0.05贴为差异具有统计学意义。结果强化胰岛素治疗组患者细胞因子、血流动力学参数明显改善,APACHEⅡ评分降低,与常规治疗组比较差异有统计学意义(P<0.05)。结论对严重多发伤患者,强化胰岛素治疗可明显改善患者的病情,减少并发症,降低病死率。
Objective To observe the effect of intensive insulin therapy on the prognosis of patients with severe multiple trauma. Methods Sixty-two patients with severe multiple trauma who were admitted to Zhongshan Hospital Affiliated to Dalian University from June 2006 to June 2009 were selected. Patients with severe recent illness, ISS> 16 and injured more than two anatomical sites They were randomized into two groups: intensive insulin treatment (n = 31) and conventional treatment (n = 31). Intensive insulin treatment group on admission insulin pump control blood glucose in the 4.0 ~ 6.1mol / L, conventional treatment group blood sugar control in the 10.0 ~ 11.0mol / L. The changes of blood TNF-a, IL-1, IL-6, CRP and the changes of APACHEⅡscore in two groups were observed. The cure rate was observed. Statistical data with mean ± standard deviation (χ - ± s) that by SPSS10.0 software using t-test and one-way analysis of variance, P <0.05 posted as statistically significant differences. Results In the intensive insulin treatment group, the hemodynamic parameters were significantly improved and the APACHE Ⅱ score was decreased. The difference was statistically significant (P <0.05) compared with the conventional treatment group. Conclusion For patients with severe multiple trauma, intensive insulin therapy can significantly improve the patient’s condition, reduce complications and reduce mortality.