不同血清胰岛素水平对儿科重症监护病房患儿的影响

Influence of Serum Insulin Levels on Children in Pediatric Intensive Care Unit

目的:探讨空腹血清胰岛素水平对儿科重症监护病房(PICU)患儿的影响。方法:PICU收治患儿262例,根据患儿入院时空腹胰岛素水平分为正常胰岛素组(正常组)112例,胰岛素轻度升高组(轻度组)78例,胰岛素重度升高组(重度组)72例,检测患儿血液常规及生物化学指标,记录患儿危重病例评分(PCIS)、急性生理学及慢性健康评分(APACHEⅡ)、简化急性生理评分(SAPSⅡ)、全身性感染相关性器官功能衰竭评分(SOFA),并发症发生情况及患儿预后。结果:与对照组和轻度组比较,重度组APACHEⅡ评分、SAPSⅡ评分、SOFA评分较高,而PICS评分则较低,差异有统计学意义(P<0.05);重度组休克发生率、心力衰竭、呼吸衰竭、神经功能衰竭、多器官功能障碍综合征、肝功能衰竭发生率显著高于胰岛素轻度升高组及对照组,差异有统计学意义(P<0.05);与正常组和轻度组比较,重度组WBC、CRP、FBG、BUN、LDH及CK-MB水平显著升高,而Ca2+则显著降低,差异有统计学意义(P<0.05);重度组死亡率高于正常组及轻度组,PICU时间及平均住院时间显著长于轻度组及对照组,差异有统计学意义(P<0.05)。结论:动态监测PICU患儿胰岛素水平对预测患儿病情进展及预后具有重要的意义。

Objective： To investigate the effect of fasting serum insulin level on pediatric intensive care unit （PICU） children. Methods： A total of 262 PICU children were divided into normal insulin group （112 cases, normal group） , insulin slightly elevated group （78 cases, mild group）, severely el- evated group （72 cases, severe group）. Routine blood test was carried out and biochemical indexes were detected. The scores of PCIS, APACHE Ⅱ , SAPS Ⅱ and SOFA of the children were recorded. The complication and prognosis were compared among the three groups. Results： The scores of A- PACHE Ⅱ , SAPS Ⅱ, SOFA in severe group were higher than those in control group and mild group, while PICS scores were lower than those in the two group （P 〈 0.05 ）. The incidences of shock, heart failure, respiratory failure, nerve failure, multiple organ dysfunction syndrome, liver function failure in severe group were significantly higher than those in the other two groups, and the levels of WBC, CRP, FBG, BUN, LDH and CK-MB were significantly increased and Ca2＋ were significantly de- creased as compared with the other two groups （P 〈 0.05 ）. The mortality of severe group were higher than that in the other two groups, PICU time and hospitalization time were longer than those of the oth- er two groups （ P 〈 0.05 ）. Conclusions： Dynamic monitoring insulin levels is significant in predicting disease progression and prognosis of PICU children.