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目的:探讨胰岛素强化治疗对高原地区严重创伤合并应激性高血糖患者的影响。方法:40例青海省人民医院急诊科(青海省成人急救中心)EICU病房的严重创伤合并应激性高血糖患者(ISS≥25分),随机分为强化治疗组(Ⅰ组)(n=20)和常规治疗组(M组)(n=20),Ⅰ组血糖控制在(4.4~6.1)mmol/L,M组血糖控制在(10.0~11.1)mmol/L,观察并测定两组治疗前和治疗后第1、2、4、6、8天血清C-反应蛋白(C-reactive Protein,CRP)、白细胞介素-6(Interleukin-6,IL-6)和肿瘤坏死因子(Tumor necrosis factor-α,TNF-α);并观察两组患者ICU住院天数、MODS发生率、病死率及低血糖发生率,并相比较。结果:40例严重创伤患者治疗前血清CRP、IL-6、TNF-α较正常水平均明显升高,治疗组血清CRP、IL-6在治疗后第4天与M组对比差异有统计学意义(P<0.05),TNF-α从治疗后第1天开始低于M组(P<0.05),在治疗后第6天下降有更明显的趋势,差异有统计学意义(P<0.05)。Ⅰ组在ICU住院天数、MODS发生率、病死率均明显低于M组,低血糖发生率与M组比较无明显差异(P<0.05)。结论:高原地区严重创伤合并应激性高血糖时,采用胰岛素强化治疗,控制血糖在(4.4~6.1)mmol/L水平,可降低患者血清炎症因子CRP、IL-6、TNF-α的水平,从而降低ICU住院天数、MODS发生率、病死率,但并不增加低血糖发生率。
Objective: To investigate the effect of intensive insulin therapy on patients with severe trauma combined with stress hyperglycemia in the high altitude area. Methods: Forty patients with severe traumatic stress and hyperglycemia (ISS≥25) in the emergency department of Qinghai Provincial People’s Hospital (Qinghai Provincial Adult First Aid Center) were randomly divided into intensive treatment group (group Ⅰ) (n = 20) (N = 20). The blood glucose of group Ⅰ was (4.4 ~ 6.1) mmol / L and that of group M was (10.0 ~ 11.1) mmol / L. And serum C-reactive protein (CRP), interleukin-6 (IL-6) and tumor necrosis factor (Tumor necrosis factor) on the 1st, -α, TNF-α). The length of hospital stay, MODS incidence, mortality and incidence of hypoglycemia in both groups were observed and compared. Results: Serum levels of CRP, IL-6 and TNF-α were significantly increased in 40 severe trauma patients before treatment compared with those in M group. The serum CRP and IL-6 levels in the treatment group were significantly different from those in the M group (P <0.05). The TNF-αdecreased from the first day after treatment to that in the M group (P <0.05), and there was a more obvious trend on the sixth day after the treatment. The difference was statistically significant (P <0.05). The days of hospital stay, MODS incidence and mortality in group Ⅰ were significantly lower than those in group M. There was no significant difference in the incidence of hypoglycemia between group Ⅰ and group M (P <0.05). CONCLUSIONS: When intensive traumatic injury combined with stress hyperglycemia in high altitude area, intensive insulin therapy and blood glucose control (4.4 ~ 6.1 mmol / L) can reduce the level of serum inflammatory cytokines CRP, IL-6 and TNF-α, Thus reducing ICU hospital stay, MODS incidence, mortality, but does not increase the incidence of hypoglycemia.