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目的:探讨胰岛素强化治疗对脓毒症患者血清超敏C反应蛋白(hs-CRP)、肿瘤坏死因子(TNF)-α和白介素(IL)-6水平的影响及疗效观察。方法:脓毒症患者74例随机分为强化组(37例)和常规组(37例)。两组患者均予常规治疗。强化组患者入院次日予胰岛素持续泵入,控制血糖4.4~6.1 mmol·L-1;常规组患者入院次日常规使用胰岛素治疗,控制血糖10.0~11.9 mmol·L-1。观察两组患者治疗前和治疗7 d后血hs-CRP、TNF-α和IL-6水平变化,并比较两组治疗期间普通胰岛素用量、临床疗效及药品不良反应。结果:治疗7 d后,两组患者血清hs-CRP、TNF-α和IL-6水平均有不同程度的下降(P<0.01或0.05),且强化组下降幅度明显大于常规组(P<0.05)。强化组临床总有效率为94.59%,明显高于常规组的75.68%(P<0.05),强化组普通胰岛素平均用量明显高于常规组(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:胰岛素早期强化治疗脓毒症患者疗效肯定,能明显降低血清hs-CRP、TNF-α和IL-6水平的影响,可更好地抑制机体炎症反应,改善患者的预后。
Objective: To investigate the effect of intensive insulin therapy on the levels of serum hs-CRP, TNF-α and IL-6 in patients with sepsis and the therapeutic effect. Methods: Seventy-four patients with sepsis were randomly divided into intensive group (37 cases) and conventional group (37 cases). Both groups were treated routinely. In the intensive group, insulin was pumped continuously on the next day to control the blood glucose level from 4.4 to 6.1 mmol·L-1. Conventional patients were treated with insulin routinely on the next day after admission to control the blood glucose level from 10.0 to 11.9 mmol·L-1. The levels of hs-CRP, TNF-α and IL-6 in blood before and 7 days after treatment were observed in two groups. The dosage of common insulin, clinical efficacy and adverse drug reactions were compared between the two groups. Results: Serum levels of hs-CRP, TNF-α and IL-6 in both groups decreased to some extent after 7 days of treatment (P <0.01 or 0.05), and decreased more significantly in the intensive group than in the conventional group ). The total effective rate of the intensive group was 94.59%, which was significantly higher than that of the conventional group (75.68%, P <0.05). The average amount of insulin in the intensive group was significantly higher than that of the conventional group (P <0.05). Two groups of patients with adverse reactions, the difference was not statistically significant (P> 0.05). CONCLUSION: The positive effect of early insulin treatment on sepsis patients affirmed that it can significantly reduce the serum hs-CRP, TNF-α and IL-6 levels, and can better inhibit the body’s inflammatory response and improve the prognosis of patients.