强化胰岛素治疗对严重多发伤患者炎症因子水平及预后的影响

Effects of intensive insulin therapy on the level of inflammatory factors and prognosis in severe multiple trauma patients

目的：观察强化胰岛素治疗对严重多发伤患者炎症因子及预后的影响。方法将53例严重多发伤患者随机分为治疗组（27例）和对照组（26例）。治疗组患者在基础治疗的基础上，加用胰岛素微量泵强化治疗，对照组血糖控制在11．1 mmol／L 以下，分别在治疗前、后测定患者的肿瘤坏死因子（TNF-α）、白细胞介素（IL-1β）、IL-6、C 反应蛋白（CRP）水平，并观察多器官功能障碍综合征、院内感染发生率和病死率。结果治疗组患者的TNF-α、IL-1β、IL-6、CRP 水平显著低于对照组，差异有统计学意义（P ＜0．05或 P ＜0．01），治疗组多器官功能障碍综合征、院内感染发生率及病死率低于观察组（P ＜0．05）。结论强化胰岛素治疗可降低严重多发伤患者的炎症因子的表达水平，改善患者预后，降低院内感染的发生率及死亡率。

Objective To observe the influence of intensive insulin therapy on inflammatory fac-tors and prognosis in severe multiple trauma patients.Methods A total of 53 cases of severe multiple trauma were randomly divided into the treatment group（n =27）and the control group（n =26）.Besides basic treatment,patients in the treatment group received additional intensive insulin therapy by micro-pump.The level of blood glucose in the control group was controlled under 11.1 mmol/L.Levels of TNF-α,IL-1β,IL-6,and CRP were tested before and after treatment.Multiple organ dysfunction syndrome,noso-comial infection rate,and mortality rate were also observed.Results The levels of TNF-α,IL-1β,IL-6, and CRP in the treatment group were significantly lower than those of the control group（P ＆lt;0.05 or P ＆lt;0.01）.The incidence of multiple organ dysfunction syndrome,nosocomial infection,and mortality rate in the treatment group was lower（P ＆lt;0.05）.Conclusion Intensive insulin therapy can effectively decrease the expressions of inflammatory factors in patients with severe multiple trauma,improve the prognosis,re-duce the incidence of nosocomial infection and mortality.