小剂量胰岛素对严重烧伤延迟复苏患者心肾损害的保护作用

Effect of Insulin on Heart and Kidney Damage in Burned Patients with Delayed Fluid Resuscitation

目的:探讨胰岛素干预对严重烧伤延迟复苏患者心、肾损害的保护作用。方法:将50例严重烧伤延迟复苏患者,于烧伤6 h后连续3 d每日皮下注射甘精胰岛素,根据注射剂量分为对照组、0. 05 U/(kg·d)组、0. 10 U/(kg·d)组、0. 15 U/(kg·d)组及0. 20 U/(kg·d)组,并于注射后6、12、24、48、72 h采集静脉血,分离血清,采用分光光度法测定血糖、肌酸激酶(CK)、乳酸脱氢酶(LDH)、尿素氮(BUN)、肌酐(Cr)),免疫抑制法测定肌酸激酶同工酶(CK-MB)。结果:对照组血糖、CK、CK-MB、LDH、BUN及Cr水平均显著高于甘精胰岛素注射组,且烧伤3 d后仍处于高值(P <0. 05); 0. 05 U/(kg·d)组血糖、CK、CK-MB、LDH、BUN、Cr水平均显著低于对照组,高于0. 10 U/(kg·d)组、0. 15 U/(kg·d)组及0. 20 U/(kg·d)组(P <0. 05); 0. 10 U/(kg·d)组、0. 15 U/(kg·d)组及0. 20 U/(kg·d)组血糖、CK、CK-MB、LDH、BUN、Cr逐渐降低,部分结果正常; 0. 20 U/(kg·d)组结果烧伤72 h后各指标基本正常,偶有低血糖反应。结论:小剂量甘精胰岛素干预对严重烧伤延迟复苏患者心、肾损害有保护作用。

Objective：To investigate the protective effect of insulin against heart and kidney damage in burned patients with delayed fluid resuscitation. Methods： 50 patients with severe burn delayed resuscitation （without diabetes mellitus） were randomly divided into 5 groups according to the injection doses of insulin glargine （0 U/kg·d, 0.05 U/kg·d, 0.1 U/kg·d, 0.15 U/kg·d and 0.2 U/kg·d respectively） and were injected subcutaneously daily in 6h after burn （three days in succession）.The vein blood was collected in 6 h, 12 h, 24 h, 48 h and 72 h after injection of insulin glargine. A spectrophotometric method for the determination of glucose, creatine kinase （CK）, lactate dehydrogenase （LDH）, blood urea nitrogen（BUN）, creatinine （Cr）,creatine kinase MB （CK-MB） were determined by immunosuppression. Results： The blood glucose, CK, CK-MB, LDH, BUN and Cr of Group 1（the controls with 0 U/kg·d） were significantly higher than those of Groups 2-5, and three days after burn were still at a high level （ P 〈0.05）; The blood glucose, CK, CK-MB, LDH, BUN and Cr of Group 2 were significantly lower than those of the controls, higher than those of Group 3-5 and 3 days after the burn the measurement value was low （ P 〈0.05）; The blood glucose, CK, CK-MB, LDH, BUN and Cr were gradually lower in Groups 3 , 4 and 5, with partly normal results. The results of Group 5 were basically normal 72 h after the burn, and there was hypoglycemia （ P 〈0.05）. Conclusion： Low dose injection of insulin glargine has protective function against heart and kidney damage in patients with severe burn delayed resuscitation.