重症感染合并应激性高血糖患者短期强化血糖控制效果研究

Effects of short-term intensive treatment on blood glucose control in patients with severe infection complicated by stress hyperglycemia

目的探讨重症感染合并应激性高血糖患者进行短期强化血糖的控制效果。方法收集收治的重症感染合并应激性高血糖患者84例,随机分为强化组和对照组,每组42例。强化组患者采用短期胰岛素强化治疗将血糖控制在4.0~6.1 mmol/L,对照组患者采用常规胰岛素治疗将血糖控制在8.0~10.0 mmol/L,比较2组患者免疫系统内T淋巴细胞亚群水平(CK_4^+、CK_8^+和CK_4^+/CK_8^+)、血清炎性指标(CRP、IL-6、TNF-α)及空腹血糖(FPG)水平,比较2组患者血糖达标时间、病死率及低血糖事件情况。结果强化组患者的CK_4^+、CK_4^+/CK_8^+水平高于对照组,CK_8^+水平低于对照组(P<0.05);强化组患者的CRP、IL-6、TNF-α下降水平明显优于对照组(P均<0.05);强化组患者入院第3、7天的FPG水平明显低于对照组(P<0.05);强化组的低血糖发生率高于对照组,血糖达标时间及28 d病死率均低于对照组(P<0.05);死亡组患者入院时APACHEⅡ评分、血糖达标时间与生存组患者差异有统计学意义(P<0.05),FPG水平和低血糖发生率差异无统计学意义(P>0.05);第3、7天,死亡组患者FPG水平及血糖变异性与生存组患者差异有统计学意义(P<0.05);Logistic回归分析显示,入院时APACHEⅡ评分(OR=2.214)和血糖变异性(OR=1.375)为影响患者死亡的独立危险因素。结论对重症感染合并应激性高血糖患者实施短期强化血糖控制,FPG水平明显下降,并可增强其免疫功能,改善炎性反应,利于预后。

Objective To investigate the ffects of short-term intensive treatment on blood glucose control in patients with severe infection complicated by stress hyperglycemia. Methods Eighty-four patients with severe infection complicated by stress hyperglycemia who were admitted and treated in our hospital from November 2014 to October 2015 were randomly divided into intensive treatment group and control group,with 42 patients in each group. The patients in intensive treatment were treated by short-term intensive insulin treatments,and patient＇s blood glucose was controlled between 4. 0 ~ 6. 1 mmol/L,however,the patients in control group were treated by conventional insulin therapy,with blood glucose being controlled between 8. 0 ~ 10. 0 mmol/L. The levels of T lymphocyte subsets including CD_4~＋,CD_8~＋ and CD_4~＋/CD_8~＋,and serum inflammatory indexes including CRP,IL-6,TNF alpha were detected for both groups,moreover,the levels of fasting plasma glucose（ FPG）,therapeutic time,case fatality rate and incidence rate of hypoglycemia event were observed and compared between two groups.Results The levels of CD_4~＋,CD_4~＋/CD_8~＋ in intensive treatment group were significantly higher than those in control group（ P〈 0. 05）,however,the levels of CD_8~＋ in intensive treatment group were significantly lower than those in control group（ P〈 0. 05）. The decrease degree of CRP,IL-6,TNF-α levels in intensive treatment group was more obvious than that in control group（ P〈 0. 05）. On 3,7 day after admission to hospital the FPG levels in intensive treatment group were significantly lower than those in control group（ P 〈0. 05）,however,the incidence rate of hypoglycemia in intensive treatment group was significantly higher than that in control group（ P〈 0. 05）,moreover,the therapeutic time and 28-day case fatality rate in intensive treatment group were significantly lower than those in control group（ P 〈0. 05）. On admission to hospital,there were significant differences in the APACHE Ⅱ score,therapeutic time between death case group and survival case group（ P〈 0. 05）,however,there were no significant differences in the FPG levels and incidence rate of hypoglycemia between death case group and survival case group（ P〉 0. 05）. Logistic regression analysis showed that APACHE Ⅱ score（ OR = 2. 214） and blood glucose variability（ OR = 1. 375） were independent risk factors of influencing mortality of patients. Conclusion The short-term intensive blood glucose control in treatment of severe infection complicated by stress hyperglycemia can decrease FPG levels obviously,and can enhance patient＇s immune function,improve the inflammatory response,thus,which is good for prognosis of patients.