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目的:采用强化胰岛素治疗对脓毒血症患者应激性高血糖进行早期干预并观察临床效果。方法:以78例脓毒血症患者为研究对象,随机分为常规治疗组(CG组,n=38例)和强化胰岛素治疗组(IIG组,n=40例),采用经静脉微量泵连续输注胰岛素的方式控制两组患者血糖水平,CG组餐前血糖水平控制在10.0-11.1mmol/L范围内,IIG组餐前血糖水平控制在4.4-6.1mmol/L范围内。采用酶联免疫吸附法检测两组患者治疗第0、3、6、9及12天时血清钙卫蛋白(SC)、肿瘤坏死因子(TNF)-α、白细胞介素(IL)-6的表达水平,并比较两组患者机械通气、抗生素使用及ICU住院时间、低血糖发生率、急性肾衰竭及死亡率等临床指标。结果:IIG组在机械通气时间、抗生素使用时间、ICU住院时间、急性肾衰竭(ARF)发生率及死亡率均较CG组显著下降(P<0.05),其中急性肾衰竭(ARF)发生率与患者的死亡率显著相关(r=0.945,P<0.05);与常规治疗组比较,治疗第6、9及12天血清SC表达水平均显著下降(P<0.05);发生ARF的患者,在治疗各时段血清SC水平均显著高于非ARF的患者(P<0.05);两组患者TNF-α、IL-6水平都呈现明显下降趋势,组内各时间点比较,治疗第3、6、9、12天均较治疗第0天的水平显著下降(P<0.05)。结论:强化胰岛素治疗脓毒血症有显著疗效,可降低血清SC、TNF-α及IL-6表达水平,降低患者死亡率,血清SC水平可能是一个独立的影响脓毒血症预后的因素。
OBJECTIVE: To investigate the clinical effects of intensive insulin therapy on stress hyperglycemia in sepsis patients. Methods: Totally 78 patients with sepsis were randomly divided into routine treatment group (n = 38 in CG group) and intensive insulin treatment group (n = 40 in n = 40) The way of insulin infusion was to control the blood sugar level in both groups. The pre-meal glucose level in CG group was controlled in the range of 10.0-11.1mmol / L and the pre-meal glucose level in IIG group was in the range of 4.4-6.1mmol / L. The levels of serum calprotectin (SC), tumor necrosis factor (TNF) -α and interleukin (IL) -6 were detected by enzyme-linked immunosorbent assay , And compared the clinical indicators of mechanical ventilation, antibiotic use, length of hospital stay, incidence of hypoglycemia, acute renal failure and mortality in the two groups. Results: Compared with CG group, the incidence of mechanical ventilation, antibiotic use time, ICU hospital stay, acute renal failure (ARF) and mortality in IIG group were significantly decreased (P <0.05), and the incidence of acute renal failure (ARF) (R = 0.945, P <0.05). Compared with the conventional treatment group, the expression of SC in serum was significantly decreased on the 6th, 9th and 12th days after the treatment (P <0.05). In the patients with ARF, The levels of serum SC in each time period were significantly higher than those in non-ARF patients (P <0.05). The levels of TNF-α and IL-6 in both groups showed a significant decreasing trend at each time point, (P <0.05), while the level of 12 days was significantly lower than that on the 0th day of treatment (P <0.05). Conclusion: Intensive insulin treatment of sepsis has a significant effect, can reduce serum levels of SC, TNF-α and IL-6, reduce patient mortality, serum SC levels may be an independent prognostic factor affecting sepsis.