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目的探讨胰岛素早期强化治疗对脓毒症患者血清内毒素、二胺氧化酶(DAO)和D-乳酸指标的影响及疗效。方法 70例脓毒症患者随机分为强化组(35例)和普通组(35例)。两组均予以控制感染、能量营养支持和治疗基础疾病等常规治疗,必要时予以机械通气或血管活性药物治疗。强化组将胰岛素加入微量泵持续泵入,调整速度24h内血糖控制在4.4~6.1mmol/L;普通组常规使用胰岛素治疗,24h内血糖控制在10.0~11.1mmol/L。判断并记录两组治疗前和治疗7d后血清内毒素、DAO和D-乳酸变化,并评估其疗效。结果治疗7d后,两组血清内毒素、DAO和D-乳酸指标[(0.20±0.048)EU/mL、(2.92±0.43)U/mL、(0.11±0.03)mmol/L,(0.27±0.06)EU/mL、(3.78±0.50)U/mL、(0.17±0.03)mmol/L]较前[(0.37±0.07)EU/mL、(4.52±0.61)U/mL、(0.24±0.05)mmol/L,(0.36±0.08)EU/mL、(4.47±0.64)U/mL、(0.23±0.04)mmol/L]明显下降(t=4.25、2.89、3.48、2.37、2.19、2.41,P<0.01或P<0.05),且强化组下降值更明显(t=2.31、2.21、2.43,P<0.05);在临床总有效率方面强化组(94.29%)明显高于普通组(77.14%)(χ2=4.20,P<0.05)。结论胰岛素早期强化治疗脓毒症的疗效较显著,可降低内毒素、DAO和D-乳酸水平,降低肠黏膜通透性。
Objective To investigate the effects and early effects of early intensive insulin therapy on serum endotoxin, diamine oxidase (DAO) and D-lactic acid in septic patients. Methods Seventy patients with sepsis were randomly divided into intensive group (35 cases) and general group (35 cases). Both groups were given conventional therapy of infection control, energy and nutrition support and treatment of underlying diseases, and mechanical ventilation or vasoactive drug treatment when necessary. In the intensive group, the insulin was added into the micropump and pumped continuously. The blood glucose was controlled within 4.4 ~ 6.1 mmol / L within 24 hours and the insulin routinely used in the general group. The blood glucose was controlled within 10.0 ~ 11.1 mmol / L within 24 hours. Judge and record the changes of serum endotoxin, DAO and D-lactic acid before treatment and after 7 days of treatment, and evaluate the curative effect. Results Serum levels of endotoxin, DAO and D-lactic acid ([0.20 ± 0.048] EU / mL, (2.92 ± 0.43) U / mL, (0.11 ± 0.03) mmol / L and (0.27 ± 0.06) (0.37 ± 0.07) EU / mL, (4.52 ± 0.61) U / mL, (0.24 ± 0.05) mmol / L, (T = 4.25, 2.89, 3.48, 2.37, 2.19, 2.41, P <0.01 or (0.36 ± 0.08) EU / mL, (4.47 ± 0.64) U / mL, (T = 2.31,2.21,2.43, P <0.05). The total effective rate of the intensive group (94.29%) was significantly higher than that of the common group (χ2 = 4.20, P <0.05). Conclusion Early treatment of sepsis with insulin is more effective and can reduce endotoxin, DAO and D-lactic acid levels and reduce intestinal mucosal permeability.