胰岛素强化治疗对多发伤伴应激性糖尿病患者相关指标的影响

Effects of Intensive Insulin Therapy on Related Indexes of Stress Diabetes Patients with Multiple Trauma

目的:探讨胰岛素强化治疗对多发伤伴应激性糖尿病患者相关指标的影响。方法:82例多发伤伴应激性糖尿病患者随机分为观察组和对照组,每组41例。两组患者均结合创伤情况进行针对性处理和常规治疗。在此基础上,观察组患者给予生物合成人胰岛素注射液,微量泵滴注,滴速为1~2 IU/h,并根据实时血糖值调节胰岛素微量泵的滴速;对照组患者给予盐酸二甲双胍片起始剂量0.5 g,每日2次,随餐服用,根据患者血糖监测结果适当增加剂量至1 g,每日2次。两组均连续治疗10 d。观察两组患者治疗前后血清C反应蛋白(CRP)、肿瘤坏死因子α(TNF-α)、白细胞介素1(IL-1)、IL-6、平均血糖值,局部感染、脓毒症和全身炎症反应综合征等并发症发生情况及不良反应发生情况。结果:治疗后,两组患者血清CRP、TNF-α、IL-1、IL-6、平均血糖值水平均显著低于同组治疗前,且5、10 d后观察组患者血清CRP、IL-1、IL-6水平和1、5、10 d后TNF-α、平均血糖值均显著低于对照组同期,差异均有统计学意义(P<0.05)。观察组患者并发症总发生率显著低于对照组,差异有统计学意义(P<0.05)。两组患者治疗期间均未见明显不良反应发生。结论:在常规治疗的基础上,胰岛素强化治疗多发伤伴应激性糖尿病能够更加有效地降低患者血糖和炎症因子水平,防止多发伤后并发症的发生,且不增加不良反应的发生。

OBJECTIVE： To investigate the effects of intensive insulin therapy on related indexes of stress diabetes patients with multiple trauma. METHODS： 82 stress diabetes patients with multiple trauma were randomly divided into observation group and control group, with 41 cases in each group. Two groups were given specific processing. Observation group was additionally given biosynthetic human insulin therapy with 1-2 IU/h drops of micro pump, adjusting dripping speed of micro pump according to re- al-time blood glucose value. Control group was given metformin hydrochloride tablets, with a meal, the initial dose of 0.5 g, twice a day, adjusting the dose of glucose-lowering drugs according to blood glucose value, increasing the dose to 1 g, twice a day. Both groups were treated for 10 d. CRP, TNF-α, IL-1, IL-6, average blood glucose were observed in 2 groups before and after treatment. The occurrence of complications as local infection, sepsis and SIRS were compared between 2 groups. RESULTS： After treatment, the serum levels of CRP, TNF-α, IL-1, IL-6, average blood glucose in 2 groups were significantly lower than before, and the serum level of CRP, IL-1, IL-6 in observation group after 5, 10 d of treatment and the serum level of TNF-α, average blood glucose after 1, 5, 10 d of treatment was significantly lower than control group at same time, with statistical significance （P〈0.05）. The incidence of complications in observation group after multiple trauma was significantly lower than control group, with statistical significance （P〈0.05）. No obvious ADR was found in 2 groups during treatment. CONCLUSIONS： Based on routine treatment, intensive insulin therapy can more effectively reduce the levels of blood glucose and inflammatory factors and prevent the occurrence of complications after multiple trauma, moreover, do not increase the occurrence of ADR.