强化血糖调控在危重烧伤患者治疗中的临床价值

Clinical value of intensive glucose control in the treatment of severely burned patients

目的评价强化血糖调控对危重烧伤患者治疗过程中的高血糖反应、糖代谢、创面愈合能力及预后的影响。方法选择36例严重烧伤无糖尿病史的男性患者,随机分为两组,试验组（18例）予以强化胰岛素治疗,而对照组（18例）则予以常规胰岛素治疗,两组均于伤后3~7 d内行切、削痂植皮手术,术后连续14 d每晨皮下注射重组人生长激素（rhGH）。观察两组患者血糖、血钾的变化,记录两组创面愈合时间、住院时间、并发症发生率及病死率。结果试验组治疗过程中血糖、血钾水平均显著低于对照组组（P〈0.05）,而且试验组的创面愈合时间、住院时间、并发症发生率及病死率也少于对照组（P〈0.05）。结论强化血糖调控能有效控制严重烧伤后的高血糖反应和消除rhGH的副作用,促进糖代谢,缩短创面愈合时间,减少并发症发生率及病死率。

Objective： To evaluate the effects of intensive glucose control therapy on hyperglycemia,metabolism,wound healing and prognosis in severely burned patients.Methods 36 severely burned male patients without diabetes were randomly divided into two groups： intensive glucose control group（Group Ⅰ,n=18） and conventional glucose control group（Group Ⅱ,n=18）.In Group Ⅰ,an insulin pump was used to control blood glucose at 4.4～8.3 mmol/L,and in Group Ⅱ,insulin in ordinary dose was added to glucose infusion as control.The two groups underwent skin grafting within 3～7 days after burn injury.After the operatin,all patients received rhGH every morning for 14 days.Blood samples were collected for determination of blood glucose and K＋.And healing time of burn wounds,hospitalization time,the incidence of complications and hospital mortality were also recorded.Results The concentration of blood glucose and K＋ in Group I became lower than those in group Ⅱ（P0.05）.The healing time of burn wounds,hospitalization time,the incidence of complications and hospital mortality in Group I were significantly less than those in group Ⅱ（P0.05）.Conclusions The intensive glucose control therapy for severely burned patients can effectively alleviate the hyperglycemia induced by severe burns and the side effects of rhGH,promote glucose anabolism,shorten the healing time of burn wounds and hospitalization time,and reduce the incidence of complications and hospital mortality.