烧伤后检测血儿茶酚胺类、血糖及血胰岛素的临床意义

Clinical significance of determinations of blood catecholamine,glucose and isulin in burn patients.

我们对30例住院病人用荧光分光光度法测定了不同烧伤时间、不同烧伤指数(BI)血儿茶酚胺类(CA)释放量,以期了解病人的应激状况,同时测血糖(BS)和用放射免疫法测血胰岛素(SI)。结果表明烧伤后 CA 类释放是持续性的,且有休克和感染两个高峰(P<0.05,P<0.01);CA 类释放主要是去甲肾上腺素(NE)的持续性增加,是正常量的两倍以上。休克期 CA 类释放如不增加,脓毒症阶段肾上腺素(E)与去甲肾上腺素从高值骤然下降,且低于休克期。提示:交感-肾上腺系统已处于衰竭状态,死亡似不可避免,而胰岛素分泌正常或相对不足。因此我们认为,CA 类释放增加、糖原异生、胰岛β细胞分泌受抑制,是烧伤后全过程内分泌变化的主要原因。扩容纠酸、早期切痂预防感染以及使用抗 CA 类药物是防治的主要措施。

Blood catecholamine(CA),glucose and insulin were determined in 30 severe burn pa- tients,of whom 22 were males,and 8 females.Mean burn area was 58.6 percent TBSA.These patients were in hypovolemic shock.Results:CA release was persistent in severe burn patients showing two peaks in shock period and infection period(P<0.01).The quantity of epinephrine(E)was normal, while norepinephrine(NE)was presistently high(P<0.01),and it was over two fold of the normal value.The value seemed to reflect the severity of the injury.When CA did not show a rise in the shock period,or lowered abruptly in the sepsis period,the patients were in high risk.Increasing CA produced increase in gluconeogenesis with insufficieney in SI secretion.