强化胰岛素治疗对严重多发伤患者预后的影响

Effects of intensive insulin treatment on the prognosis of severe multiple trauma patients

目的观察强化胰岛素治疗对严重多发伤患者预后的影响。方法选择2001年6月至2004年10月暨南大学医学院第三附属医院外科ICU与中山医科大学第一附属医院外科ICU所收治的严重多发伤患者62例,近期无严重疾病史,ISS>16分者且伤及两个以上解剖部位的患者,将其随机分成两组:强化胰岛素治疗组(n=31),常规治疗组(n=31)。强化胰岛素治疗组入院后即上胰岛素泵控制血糖在4.0～6.1 mol/L,常规治疗组血糖控制在10.0～11.0 mol/L。观察两组患者治疗后血液TNF-α、IL-1、IL.6、CRP的变化以及APACHEⅡ评分的变化、治愈率。统计数据以均数±标准差(x±s)表示,经SPSS 10.0软件用成组t检验及单因素方差分析,以P<0.05为差异具有统计学意义。结果强化胰岛素治疗组患者细胞因子、血流动力学参数明显改善,APACHEⅡ评分降低,与常规治疗组比较差异有统计学意义(P<0.05)。结论对严重多发伤患者,强化胰岛素治疗可明显改善患者的病情,减少并发症,降低死亡率。

Objective To observe the effects of intensive insulin treatment on prog nonosis of severe multiple trauma patients. Method From June 2001 to October 2004, 62 patients suffered from severe multiple trauma were selected from Department of Surgical Intensive Care Unit, The Third Affiliated Hospital, Jinan University Medical College and Department of Surgical Intensive Care Unit, and the First Affiliated Hospital, Sun Yat-sen University. The selected patients had no history of severe disease, with ISS 〉 16 and the distribution of severe trauma more than 2 anatomic parts. They were randomly divided into two groups ： intensive insulin treatment group （n = 31） and control group （n = 31）. Intensive insulin treatment group received insulin with insulin pump in order to maintain blood glucose levels at 4.0 - 6.1 mol/L, while the control group received routine insulin treatment in order to mmaintain blood glucose levels at 10.0- 11.0 mol/L. Plasma levels of TNF-α, IL-1, IL-6, CRP, APACHE Ⅱ scores and cure rate were analyzed before and after the treatment. Data was expressed as mean ± standard deviation. Two- tailed T test and ANOVA were used for comparison in SPSS 10.0, and changes were considered as statistically significant if P value was less than 0.05. Results After the intensive insulin treatment, patient＇s hemodynamic parameter apparently improved, APACHE Ⅱ scores descended, and the levels of TNF-α, IL- 1, IL-6, CRP all declined. In comparison with control group, there were significant differences. Conclusions Intensive insulin treatment might improve patient＇s general condition and decrease comphcations and mortality of severe multiple trauma.