感染中毒症合并应激性高血糖患者胰岛素强化治疗的疗效观察

Observation on Therapeutic Effect of Intensive Insulin Therapy in Patients With Sepsis Complicated With Hyperglycemia

目的：探讨胰岛素强化治疗对感染中毒症合并应激性高血糖患者的疗效及其可能的机制。方法：将52例感染中毒症合并应激性高血糖患者随机配对分成强化组（用胰岛素将血糖控制在4．4～6．1mmol／L）和常规组（血糖控制在10．0～11．1mmol／L）。观察并比较两组患者呼吸机使用天数、抗生素使用天数、ICU住院天数、MODS的发生率及ICU住院病死率。同时分别于转入ICU后1、3、5、7d采用ELISA检测血清TNF-α及IL-6水平，并监测CRP变化。结果：强化组的呼吸机使用天数、抗生素使用天数及ICU住院天数均较常规组缩短，其差异有统计学意义（P〈0.05）。强化组有5例（19．2％）并发MODS，常规组有12例（46．2％）并发MODS，两者差异有统计学意义（P〈0.05）。强化组ICU病死率较常规组有所下降，但无统计学意义（P〉0．05）。治疗后3、5、7d强化组TNF-α、IL-6及CRP血浆浓度明显低于常规组，其差异有统计学意义（P〈0.05）。结论：胰岛素强化治疗可减少感染中毒症合并应激性高血糖患者呼吸机与抗生素的使用时间，缩短ICU住院时间，降低MODS的发生率，其机制可能与促进合成代谢作用及其抗炎效应相关。

Objective： To investigate the therapeutic effect of intensive insulin therapy on human sepsis with hyperglycemia and its potential mechanism. Methods： Fifty-two patients with sepsis complicated with hyperglycemia were randomly divided into intensive insulin therapy group （maintenance of blood glucose at a level between 4. 4 and 6. 1 mmol/L）and control group （maintenance of blood glucose at a level between 10.0 and 11.1 mmol/L）. The ICU mortality, clays of stay in ICU,days of needing mechanical ventilation, using antibiotics and the morbidity of multi- ple organ dysfunction syndrome （MODS） were compared between two groups. Serum levels of TNF-α, IL-6 and CRP were determined on 1, 3, 5, 7 days respectively after admission. Results： Days in ICU,days of needing mechanical ventilation,using antibiotics were shorter in the intensive therapy group than those in control group （P〈0.05）. Five cases（19. 2%）complicated with MODS in intensive therapy group and 12 cases （46. 2%） complicated with MODS in control group, there was statistic difference between two groups （P〈0.05）. The mortality was less in intensive therapy group than that in control group, but there was no statistic difference between two groups （P〉0. 05）. Serum levels of TNF-α, IL-6 and CPR in patients received intensive insulin therapy were significantly lower than those in patients without the therapy on 3, 5 and 7 days （P〈0.05）. Conclusion： Intensive insulin therapy can shorten the time of needing mechanical ventilator and use of antibiotics,duration in ICU,and decreased the mobidity of MODS in patients with sepsis complicated with hyperglycemia. It＇s mechanism might be related with anti-inflammatory actions of insulin,as well as promotion of anabolism.