早期强化胰岛素治疗对心肺复苏后部分炎症因子的影响

Effects of early intensive therapy with insulin on some inflammatory factors after cardiopuimonary resuscitation

目的 探讨早期胰岛素强化治疗对心脏骤停（CA）复苏后炎症因子的影响.方法 67例无糖尿病史的CA患者随机分为对照组（B组,n=34）和强化胰岛素治疗组（A组,n=33）,同期健康体检人群为正常组（C组,n=34）.B组复苏后给予常规药物治疗;A组在常规治疗基础上加用胰岛素,将血糖维持在4.3～6.1 mmol/L.分别于复苏即刻和治疗24 h后时测定两组患者的血糖、肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）、C-反应蛋白（CRP）水平,并与C组进行比较.结果 A、B组治疗前后TNF-α、IL-6、CRP均较C组升高（P＜0.05）;A组治疗24 h后,血糖、TNF-α、IL-6、CRP减低,与B组比较有显著差异（P＜0.05）.结论 在心肺复苏再灌注早期,TNF-α、IL-6、CRP均不同程度增高,说明炎症反应明显;早期强化胰岛素治疗可抑制TNF-α、IL-6、CRP水平的升高,减轻复苏后炎症反应.

Objective To discuss the effects of early intensive therapy with insulin on inflammatory factors after resuscitation for cardiac arrest （CA）. Methods Sixty seven CA patients with no history of diabetes were randomly divided into control group （ group B, u = 34 ）and early intensive insulin treatment group（ group A, n = 33 ）. Thirty four healthy people who received the health examination at the same time period were chosen as normal group （group C）. After the resuscitation, group B received the treatment with conventional medicine, and group A received insulin early based on the conventional treatment and remained the blood sugar within 4.4-6.1 mmol/L. At the time of resuscitation and 24 h after the treatment, detection was made in the levels of blood sugar, tumor necrosis factor （TNF-ct） , interleukin-6 （ IL-6 ）, and C-reactive protein （CRP） in both group A and B. Also, the comparison was made among group A, B and C. Results The levels of TNF-α, IL-6, and CRP in group A and B increased compared with those in group C before and after treatment （ P 〈 0.05 ）. The levels of blood glucose, TNF-α, IL-6, and CRP in group A decreased 24 h after the treatment, and there were significant differences between group A and B （P 〈 0.05）. Conclusion In the early stage of cardiopulmonary resuscitation, the levels of TNF-α,IL-6, and CRP all increases to different degrees, which indicates that inflammatory reaction is significant. Early intensive therapy with insulin can inhibit the increase of TNF-α, IL-6, and CRP levels and relieve the inflammatory reaction after cardiopulmonary resuscitation.