胰岛素优化疗法对重症颅脑外伤患者应激性高血糖及炎症相关因子的影响

Effect of insulin-optimized therapy on stress hyperglycemia and inflammation related factors in patients with severe craniocerebral trauma

目的观察胰岛素优化疗法对重症颅脑外伤患者应激性高血糖的治疗效果及其对炎症相关因子的影响作用。方法选取自2017年6月至2018年12月于鄂东医疗集团黄石市中心医院(湖北理工学院附属医院)重症医学科就诊的重症颅脑外伤患者274例,并将其随机分为观察组和对照组,每组137例。观察组采用胰岛素优化疗法,对照组采用常规胰岛素治疗法,观察2种不同治疗方案对重症颅脑外伤患者应激性高血糖的控制情况。结果观察组治疗后肿瘤坏死因子-α、C反应蛋白、肿瘤坏死因子受体Ⅰ、肿瘤坏死因子受体Ⅱ水平明显低于对照组,差异有统计学意义(P<0.05)。2组患者低血糖和手术伤口感染的发生率比较,差异无统计学意义(P>0.05),观察组呼吸系统和泌尿系统感染的发生率明显低于对照组,差异有统计学意义(P<0.05),观察组治疗后GCS评分明显低于对照组,差异有统计学意义(P<0.05)。结论胰岛素优化疗法可以减少重症颅脑外伤患者术后感染的发生率,减轻患者的炎症反应,改善患者预后,可以在临床中推广使用。

Objective To observe the therapeutic effect of insulin-optimized therapy on stress hyperglycemia in severe craniocerebral trauma and its influence on inflammation-related factors. Methods A total of 274 patients with severe craniocerebral trauma who were enrolled from June 2017 to December 2018 in Department of Critical Care Medicine, Huangshi Central Hospital, Edong Healthcare Group (Affiliated Hospital of Hubei Polytechnic University), they were randomly divided into the observation group and the control group with 137 patients in each group. The observation group was treated with insulin-optimized therapy, while the control group was treated with conventional insulin therapy. The control of stress hyperglycemia in patients with severe craniocerebral trauma was observed by two different treatment schemes. Results The tumor necrosis factor-α, C reactive protein, tumor necrosis factor receptor Ⅰ, tumor necrosis factor receptor Ⅱ levels in the observation group after treatment were significantly lower than those in the control group, the difference was statistically significant (P<0.05). There was no significant difference in incidence of hypoglycemia and surgical wound infection between the observation group and the control group (P>0.05), the incidence of respiratory and urinary system infection in the observation group was significantly lower than that in the control group, the difference was statistically significant (P<0.05). The GCS score in the observation group was significantly lower than that in the control group (P<0.05). Conclusion Insulin-optimized therapy can reduce the incidence of postoperative infection in patients with severe craniocerebral trauma, reduce the patient’s inflammatory response and improve the prognosis of patients. It can be widely used in clinical practice.