胰岛素早期强化治疗对儿童脓毒症患者血管内皮功能的保护作用

The protective effect of early intensive insulin treatment on vascular endothelial function in children with sepsis

目的探讨胰岛素早期强化治疗对儿童脓毒症患者血管内皮功能的保护作用。方法 70例儿童脓毒症患者被随机分为强化组与对照组,两组患儿均予以抗感染、液体复苏、营养支持和原发病治疗等基础治疗。强化组患儿用微泵将胰岛素持续泵入,调整速度使血糖24 h内维持在(4.4~6.1)mmol/L;对照组患儿予以常规胰岛素治疗,调整速度使血糖24 h内维持在(10.0~11.1)mmol/L。观察两组患儿治疗前与治疗1周后血清可溶性E选择素(s Es)、活化蛋白C(APC)和内皮特异分子-1(ESM-1)水平变化,并比较其临床疗效、抗生素使用时间,住院时间和多器官功能衰竭(MODS)发病率。结果治疗1周后,两组患儿s Es和ESM-1水平明显下调,APC水平明显上调(P<0.01或P<0.05),且强化组患儿下调或上调幅度大于对照组(P<0.05);同时强化组患儿临床总有效率优于对照组(χ2=4.20,P<0.05),强化组患儿抗生素使用时间和住院时间明显少于对照组(P<0.05),两组患儿MODS发病率比较,差异无统计学意义(P>0.05)。结论胰岛素早期强化治疗儿童脓毒症的疗效较显著,能缩短抗生素使用时间和住院时间;并降低s Es和ESM-1指标,升高APC指标,起保护血管内皮功能作用。

Objective To investigate the protective effects of early intensive insulin therapy on vascular endothelial function in children with sepsis. Methods 70 children patients with sepsis were random Ly divided into intensive group and control group. The two groups of children were given anti-infective therapy, fluid recovery, nutritional support and treatment of primary disease and other basic treatment.The patients in the intensive group were given micro-pump to continuously pump insulin,and the speed was adjusted to maintain blood glucose for 24 h within（4.4-6.1） mmol/L; the control group was given conventional insulin treatment, and the speed was adjusted to maintain blood glucose for 24 h within（10.0-11.1） mmol/L. The changes of serum soluble E-selectin（s Es）, activated protein C（APC） and endotheliumspecific molecule-1（ESM-1） levels before and after treatment were observed in both groups. The clinical efficacy, antibiotic use time, length of hospital stay and the incidence rate of multiple organ dysfunction syndrome（MODS） were compared. Results After one week of treatment, the levels of s Es and ESM-1 in both groups were significantly de creased, and APC levels were significantly increased（P〈0.01 or P〈0.05）. In the intensive group, the degree of decrease or increase was higher than that in the control group（P〈0.05）; at the same time, the total clinical effective rate in the intensive group was better than that in the control group（χ^2=4.20, P〈0.05）. The application time of antibiotics and length of stay in the intensive group were significantly less than those in the control group（P〈0.05）. There was no statistically significant difference in the incidence rate of MODS between the two groups（P〉0.05）. Conclusion The early intensive insulin therapy in children with sepsis has a significant efficacy, which can shorten the antibiotic use time and length of hospital stay, and reduce s Es and ESM-1 indicators, increase APC indicators, which plays a protective role of vascular endothelial function.