强化胰岛素在大面积烧伤休克复苏过程中的应用研究

Application study on intensive insulin in the shock recovery of extensive burn

目的探讨强化胰岛素对大面积烧伤休克患者复苏过程的治疗效果。方法纳入我院2008年1月至2014年10月收治的老年大面积烧伤休克患者84例,男63例,女21例,烧伤总面积为30%~91%（48%±10.2%）TBSA,Ⅲ度面积为15%~45%（26%±10%）TBSA。将其随机分为治疗组和对照组,每组42例。两组患者均给予常规的烧伤治疗,在此基础上,对照组给予短效胰岛素,治疗组给予强化胰岛素,疗程均为7 d。记录治疗前后所有患者的空腹血糖（FPG）、餐后2 h血糖（2hPG）、糖化血红蛋白（HbA1c）、空腹胰岛素（FINS）、稳态模型胰岛素抵抗指数（HOMA-IR）、白介素6（IL-6）、肿瘤坏死因子α（TNF-α）、分泌型卷曲相关蛋白5（SFRP5）水平,检测血清尿素氮（BUN）水平、血肌酐（Cr）水平的变化情况及预后。结果治疗前,两组各指标基线水平比较差异无统计学意义（P〉0.05）。治疗后,两组FPG、2hPG、HbA1c、BMI、FINS、HOMA-IR、TNF-α、IL-6水平均下降（P〈0.05）,SFRP5水平升高（P〈0.05）,且治疗组各项指标改善更明显（P〈0.05）;治疗3 d,两组Cr水平、病死率比较差异有统计学意义（P〈0.05）,两组BUN水平比较差异无统计学意义（P〉0.05）。结论强化胰岛素不仅可调节2型糖尿病患者的糖脂代谢,还通过影响IL-6、TNF-α、SFRP5等脂肪因子改善胰岛素抵抗,降低应激状态下的高分解代谢,降低病死率。

Objective To investigate the effect of intensive insulin on the recovery process of patients with ex- tensive burn shock. Methods Eighty-four patients with extensive burn shock in our hospital from January 2008 to Oc- tober 2014 were included. The total burn area was 30% - 91% （ 48% ±10. 2% ） TBSA, Ⅲ degree area was 15% - 45% （26%± 10% ） TBSA. All the patients were randomly divided into treatment group and control group. Patients were given conventional treatment for bums ; besides, patients in control group （ n = 42 ） received a short-acting insulin, and patients in treatment group （ n = 42） received intensive insulin, the course lasting for 7 d. The fasting plasma glu- cose （FPG） ,2 h postprandial blood glucose （2hPG） , glycated hemoglobin （HbAlc） , fasting insulin （FINS） ,homeo- stasis model insulin resistance index （HOMA-IR） , the levels of interleuldn-6 （IL-6） , tumor necrosis factor-α （TNF-α） , secreted frizzled-related protein 5 （ SFRP5 ） , serum urea nitrogen （BUN） and creatinine （Cr） and the prognosis were recorded before and after treatment. Results There was no significant difference in the baseline indexes between the two groups （ P 〉 0. 05 ）. The FPG, 2hPG, HbA1 c, BMI, FINS, HOMA-IR, TNF-α and IL-6 levels of patients de- creased significantly （ P 〈 0. 05 ） after treatment ： however, the SFRP5 increased （ P 〈 0. 05 ） after treatment, and the in- dexes in treatment group were improved more significantly than control group （ P 〈 0.05 ）. There were significant differences in Cr and mortality between the two groups （ P 〈 0. 05 ） , while no obvious difference was found in BUN （ P 〉 0. 05 ） at 3 d after treatment. Conclusion Intensive insulin can not only regulate the glucose and lipid metabolism in patients with type 2 diabetes, but also affect IL-6, TNF-α, SFRP5 and other adipokines, thus improving insulin resist- ance, decreasing the high catabolic stress state and the mortality.