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目的:探讨早期胰岛素强化治疗对脓毒症患者血管内皮细胞功能的修复及保护作用。方法:选取ICU住院治疗脓毒症患者74例,随机分为常规组和强化组。两组均给予常规对症治疗。在此基础上,常规组常规给予胰岛素治疗,控制血糖在10.0~11.1 mmol·L~(-1);强化组将胰岛素加入微量泵持续泵入,使血糖控制在6.6~8.3 mmol·L~(-1)间。观察并记录两组治疗前与治疗7 d后血清血管性假血友病因子(vWF)、血栓调节蛋白(TM)和内皮细胞特异性分子1(ESM-1)的变化情况,评估其临床效果及药品不良反应。结果:治疗7 d后,两组血清vWF、TM和ESM-1指标均较前明显下降(P<0.01或P<0.05),且强化组下降较常规组更明显(P<0.05);同时强化组临床总有效率明显高于常规组(P<0.05)。两组患者不良反应发生率比较,差异无统计学意义(P>0.05)。结论:早期胰岛素强化治疗脓毒症的疗效确切,可降低血清vWF、TM和ESM-1等指标,修复及保护血管内皮功能。
Objective: To investigate the repair and protective effect of early intensive insulin therapy on the function of vascular endothelial cells in septic patients. Methods: Seventy-four ICU patients were randomly divided into routine group and intensive group. Both groups were given conventional symptomatic treatment. On this basis, the conventional group was given insulin treatment routinely to control the blood sugar in the range of 10.0 ~ 11.1 mmol·L -1. In the intensive group, the insulin was added into the micropump and pumped continuously to control the blood glucose level at 6.6 ~ 8.3 mmol·L ~ (-1) -1). The changes of vWF, TM and ESM-1 in the two groups before and 7 days after treatment were observed and recorded, and their clinical effects were evaluated And adverse drug reactions. Results: After 7 days of treatment, the indexes of serum vWF, TM and ESM-1 in the two groups were significantly decreased (P <0.01 or P <0.05), and the decrease in the intensive group was more obvious than that in the conventional group (P <0.05) The total clinical effective rate was significantly higher than the conventional group (P <0.05). Two groups of patients with adverse reactions, the difference was not statistically significant (P> 0.05). Conclusion: Early insulin treatment of sepsis is effective and can reduce serum vWF, TM and ESM-1 and other indicators, repair and protection of vascular endothelial function.