强化胰岛素治疗对低心排血量脓毒症患者心功能的影响

Effect of intensive insulin therapy on cardiac function in sepsis patients with low cardiac output

目的:观察胰岛素强化治疗对低心排血量脓毒症患者心功能的影响。方法:将北京医院外科ICU 2013年3月至2018年7月收治的低心排血量的脓毒症患者随机分为强化组及常规组,比较2组患者在治疗后6 h及72h后的肌酸肌酶同工酶(creatine kinase-MB,CK-MB)、心肌肌钙蛋白I(cardiac troponin I,cTnI)、左心室射血分数(left ventricularejectionfraction,LVEF)及心指数(cardiacindex,CI)。结果:治疗6h后常规组LVEF值及CI高于强化组(P<0.05),强化组治疗72 h时血清CK-MB、cTn-I水平较常规组明显降低(P<0.05),LVEF值及CI高于常规组(P<0.05)。结论:对于低心排血量的脓毒症患者,急性期时(6 h)胰岛素的常规治疗能带来较好的心脏功能结果,而在后续治疗期(72 h),胰岛素强化组在达到目标血糖控制后可以有效地改善患者心肌损伤及促进心功能的恢复。

Objective:To study the effects of intensive insuline therapy on cardiac function in sepsis patients with low cardiac output Method:Severe sepsis patients with low cardiac output admitted to surgical ICU of Beijing Hospital from March 2013 to July 2018 were randomly divided into intensive group and routine group.CK-MB,cTnI,EF value and cardiac index(CI) were compared between the two groups 6 hours and 72 hours after treatment Results:After 6 hours of treatment,the value of LVEF and CI of the routine group were higher than those in the intensive group(P<0.05).After 72 hours of treatment,the levels of serum CK-MB and cTn-I in the intensive group were significantly lower than that in the routine group(P <0.05),and value of LVEF and CI in the intensive group were significantly higher than that in the routine group(P <0.05).Conclusion:For the severe sepsis patients with low cardiac output,conventional treatment of insulin in the acute phase(6 h) is more likely to result in better cardiac function,while in the subsequent treatment period(72 h),the intensive insulin therapy group has achieved target glycemic control,and can effectively improve the recovery of myocardial damage and promote cardiac function.