重症创伤患者血糖和胰岛素分泌变化及其临床意义

The Changes of Blood Glucose and Insulin Secretion in Patients with Severe Trauma

目的:探讨重症创伤患者血糖水平和胰岛素分泌变化及其临床意义。方法:168例创伤患者根据创伤情况分为轻症和重症创伤、死亡或生存亚组,比较患者的临床资料,并对患者的血糖和血浆胰岛素水平及临床预后进行分析。结果:轻症患者血糖、血浆胰岛素浓度轻度升高或不升高,重症患者或死亡亚组血糖和血浆胰岛素浓度显著上升,两组间差异比较有统计学意义(P<0.05或P<0.01);血糖和血浆胰岛素升高与不良预后相关。结论:重症创伤患者存在高血糖和胰岛素抵抗状态,严重创伤引起组织缺血、缺氧,加速葡萄糖无氧酵解过程,组织缺血缺氧和高血糖的增加会增加乳酸生成,影响细胞功能,进一步使组织损伤恶化。

Objective：To study of the changes of blood glucose and the levels of insulin in patients with severe trauma.Methods：170 trauma patients were divided into mild or severe trauma and denth or survival subgroups,he clinical data of patients were compared and the blood glucose and plasma insulin levels were tested,and the clinical outcome of patients were analyzed.Results：The levels of blood glucose and concentrations of plasma insulin slightly elevated or is not elevated in patients with mild injury,and that were increased significantly in severe or denth,the difference between the two groups was statistical significance（P〈0.05 orP〈0.01）.The levels of blood glucose and plasma insulin correlates with poor outcomes.Conclusion：Severe trauma patients with the hyperglycemia and insulin resistance status and its would causes tissue ischemia and hypoxia,the hyperglycemia accelerated anaerobic glycolysis and increased lactic acid formation,further deterioration of the tissue injury.