早期目标导向血糖治疗策略对脓毒症生物标志物及预后的影响

The effect of early goal-directed blood glucose therapy on sepsis biomarkers and prognosis

目的探讨早期目标导向血糖治疗策略对脓毒症生物标志物及其预后的影响。方法将137例脓毒症高血糖患者按随机数字表法分为两组,实验组采用早期目标导向血糖治疗策略,对照组采用传统经验式血糖方法,两组血糖控制目标均为7.8~10.0 mmol/L,收集患者血液样品,采用ELISA检测C-反应蛋白(CRP)、降钙素原(PCT)浓度,比色法测定血清乳酸(LAC),分别比较两组之间CRP、PCT、LAC在入ICU前,入ICU后1、3、5、7 d的表达水平;并比较两组血糖控制方法对脓毒症高血糖患者的28 d死亡例数、总住院天数、呼吸机治疗时间、抗生素持续使用时间、多器官功能障碍综合征(MODS)发生例数及治疗期间院内感染例数的影响。结果实验组CRP、PCT、LAC浓度水平在1、3、5、7 d均低于对照组,差异有统计学意义(P<0.01);两组CRP、PCT、LAC在入ICU前比较,差异无统计学意义(P>0.05);实验组抗生素持续使用时间、MODS发生例数、治疗期间的院内感染例数低于对照组,差异有统计学意义(P<0.05);两组28 d死亡例数、总住院天数、呼吸机治疗时间比较,差异无统计学意义(P>0.05)。结论早期目标导向血糖治疗策略的应用,减少了脓毒症高血糖患者抗生素持续使用时间、MODS发生例数以及治疗期间的院内感染例数,有效缓解病情变化,改善患者预后,也为临床治疗脓毒症提供了新的思路。

Objective To explore the effect of glycemic control goal-directed therapy on sepsis biomarkers and prognosis.Methods A total of 137 patients with septic hyperglycemia were divided into two groups according to the random number table.The goal-directed blood glucose control strategy was used in experimental group;the traditional blood glucose control method was used in control group.The value of blood sugar goal control for two groups was 7.8~10.0 mmol/L.137 patient blood samples were collected.Concentrations of C-reactive protein(CRP)and procalcitonin(PCT)were detected by ELISA,and lactic acid(LAC)concentration was detected by colorimetric method.The expression levels of CRP,PCT and LAC before were compared with those at 1,3,5 and 7 days after admission to ICU.The number of death in 28 days,the total number of hospital stays,ventilator treatment time,duration of antibiotic use,number of MODS cases,and number of nosocomial infections during treatment were compared between the two groups.Results The concentrations of CRP,PCT and LAC in the experimental group were significantly lower than those in the control group at 1,3,5 and 7 days(P<0.01).There were no significant differences in the concentrations of CRP,PCT and LAC before and after admission to the ICU(P>0.05).The duration of antibiotics administration in the experimental group,the number of MODS cases,and the number of nosocomial infections during the treatment period were significantly lower than those in the control group(P<0.05).There were no significant differences in the number of 28 d deaths,total hospital stays,and ventilator treatment time between the two groups(P>0.05).Conclusion The application of goal-directed glycemic control program could reduce the use of antibiotics,the number of MODS cases and nosocomial infections in patients with septic hyperglycemia,and could also effectively alleviate patients’conditions and improve the prognosis of patients;it should provide new ideas for clinical treatment of sepsis.