强化胰岛素治疗对脓毒症患者血清D-乳酸及前降钙素水平的影响及疗效观察

Influence and efficacy of intensive insulin on serum D-lactic acid and procalcitonin levels of patients with metastasizing septicemia

目的探讨强化胰岛素治疗对脓毒症患者血清D-乳酸及前降钙素水平的影响及疗效观察。方法选取脓毒症患者72例,随机分为强化组和对照组,每组36例。两组患者均予以抗生素抗感染、能量支持及治疗基础疾病等常规治疗,必要时行机械通气或血管活性药物。强化组患者将50 U胰岛素加入50 mL生理盐水中微量泵控制血糖5.0~7.0 mmol/L;对照组患者血糖控制在10.0~11.9 mmol/L,当血糖超过时才加用胰岛素治疗。观察两组患者治疗前和治疗7 d后血清D-乳酸及前降钙素水平的变化,并比较其临床疗效。结果治疗7 d后,两组患者血清D-乳酸及前降钙素水平均较前明显下降（P〈0.01或P〈0.05）,且强化组下降值明显大于对照组（P〈0.05）;强化组患者的临床总有效率明显高于对照组（94.44%vs.77.78%）（χ2=4.18,P〈0.05）。结论强化胰岛素治疗脓毒症患者具有较好的临床疗效,能明显降低血清D-乳酸及前降钙素水平的影响,改善肠黏膜屏障功能。

Objective To discuss the influence and efficacy of intensive insulin on serum D-lactic acid and procalcitonin levels of patients with metastasizing septicemia. Methods 72 patients with metastasizing septicemia were selected and divided into intensive group and control group at random,with 36 patients in each group. The patients in both groups were given routine medical treatments,including antibiotics to prevent infection,energy support,treatment of basic disease etc.,and mechanical ventilation or vasoactive agent when necessary. The patients in intensive group were given 50 U of insulin with 50 mL of normal saline（ NS） to control the blood sugar level at5. 0-7. 0 mmol /L by micro pump,while the control group was given insulin only when their blood sugar levels were beyond the scope of 10. 0-11. 9 mmol /L. The changes of serum D-lactic acid and procalcitonin levels of patients in both groups before and 7 days after medical treatment were observed,and the clinical efficacy was compared.Results After 7 days＇ medical treatment,the serum D-lactic acid and procalcitonin levels of patients in both groups obviously declined（ P 〈0. 01 or P 〈0. 05）,and the declining rate in intensive group was much higher than that in control group（ P 〈0. 05）. The total clinical efficiency in intensive group was much higher than that in control group（ 94. 44% vs. 77. 78%）（ χ2= 4. 18,P 〈0. 05）. Conclusion Intensive insulin has favorable clinical efficacy on metastasizing septicemia,which can obviously reduce the influence of serum D-lactic acid and procalcitonin levels and improve the Intestinal mucosal barrier dysfunction.