严重脓毒症和脓毒性休克患者复苏治疗与血糖控制的非线性相关分析研究

The nonlinear relationship between the resuscitation therapy and intensive insulin therapy in severe sepsis and septic shock patients

目的 研究严重脓毒症和脓毒性休克患者复苏治疗与应用胰岛素强化治疗应激性高血糖之间的关系,探讨非线性观点在脓毒症患者治疗中的价值.方法 回顾性分析129例严重脓毒症和脓毒性休克患者的住院资料,根据充分复苏标准完成所需时间（每6 h一组）分为8组,采用非线性最小二乘法比较各复苏组充分复苏完成所需时问与单位时间胰岛素用量之间的关系.结果 各复苏组充分复苏完成所需时间与单位时间胰岛素用量之间存在指数回归关系,指数曲线方程（^y）=e0.7393-0.0152x（a=0.739 3,b=0.015 2）,且拟合度甚佳（R2=0.976 943 6）.结论 在严重脓毒症和脓毒性休克患者的治疗过程中,复苏治疗完成的时问与机体紊乱的内分泌系统恢复有密切的关系,符合非线性观点.因此治疗上重在帮助机体重建已紊乱的网络,恢复其正常的生理谐振;而不仅仅是给予受损器官充分的支持和修复.

Objective To study the relationship between the resuscitation therapy and intensive insulin therapy on stress-induced hyperglycemia in severe sepsis and septic shock patients, and to evaluate the value on nonlinear viewpoint in the treatment of patients with sepsis.Methods The data of 129 hospitalized patients with severe sepsis and septic shock were analyzed and they were divided into eight groups every 6 hours in ascending order for full recovery.The resuscitation therapy time of each group was compared with insulin dosage in each unit time with nonlinear least square method.Results The relationship of the exponential function fit very well between the resuscitation therapy time of each group and the insulin dosage in each unit time.The exponential curve equation was （^y）=e0.7393-0.0152x（a=0.739 3, b=0.015 2） and the curve fit very well （R2=0.976 943 6）.Conclusion It conforms to the nonlinear viewpoint that the resuscitation therapy time is closely correlated with recovery of dysfunction of endocrine system during the treatment for patients with severe sepsis and septic shock.Therefore, the essence of successful treatment is to concentrate on helping the body rebuild the disorganized network and the recovery of physiological harmony rather than to support and repair the damaged organs.