重型颅脑损伤合并高血糖术后短期胰岛素强化治疗的效果分析

Analysis of clinical efficacy of short-term intensive insulin therapy for patients with severe traumatic brain injury associated with hyperglycemia after standard decompressive craniectomy

目的探讨重型颅脑损伤(TBI)合并高血糖标准大骨瓣减压术后胰岛素强化治疗的效果。方法2018年1月至2019年12月收治重型TBI合并高血糖66例,均行标准大骨瓣减压术治疗。术后按照随机数字表法随机分为观察组(胰岛素强化治疗)和对照组(胰岛素常规治疗),每组33例。两组均给予胰岛素持续静脉泵入治疗1周,观察组空腹血糖控制在3.9~6.1 mmol/L,对照组控制在8~10 mmol/L。比较分析两组治疗前及治疗后1周胰岛β细胞功能指标[胰岛素敏感指数(ISI)、胰岛素抵抗指数(HOMA-IR)]、血清炎性因子[C-反应蛋白(CRP)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)]以及并发症。结果治疗1周,两组ISI、HOMA-IR以及血清CRP、IL-6、IL-8、TNF-α水平均较治疗前均明显改善(P<0.05);而且,观察组明显优于对照组(P<0.05)。观察组感染发生率(21.21%,7/33)明显低于对照组(54.55%,18/33;P<0.05)。结论对重型TBI高血糖,术后短期胰岛素强化治疗有利于胰岛功能恢复,减轻炎性反应,降低感染发生率。

Objective To explore the effect of intensive insulin therapy after standard decompressive craniectomy on the patients with severe traumatic brain injury(TBI)associated with hyperglycemia.Methods The standard decompressive craniectomies were performed in 66 patients with severe TBI assocaited with hyperglycemia from January 2018 to December 2019.After the operation,these 66 patients were randomly divided into observation group and control group with 33 patients in each group.Both groups were given insulin by continuous intravenous pumping for 1 week.The level of fasting blood glucose was controlled at 3.9~6.1 mmol/L in the observation group and at 8~10 mmol/L in the control group.The isletβ-cell function indexes[insulin sensitivity index(ISI),insulin resistance index(HOMA-IR)],serum inflammatory factors[C-reactive protein(CRP),interleukin-6(IL-6),interleukin-8(IL-8),tumor necrosis factor-α(TNF-α)]and complications were compared between both groups before and 1 week the insulin treatment.Results The levels of ISI,HOMA-IR and serum CRP,IL-6,IL-8,and TNF-αin both groups were significantly improved 1 week after the insulin treatment compared with before treatment(P<0.05).Moreover,The levels of ISI,HOMA-IR and serum CRP,IL-6,IL-8,and TNF-αin the observation group was significantly better than those in the control group(P<0.05).The incidence of infection in the observation group(21.21%,7/33)was significantly lower than that(54.55%,18/33)in the control group(P<0.05).Conclusion For severe TBI associated with hyperglycemia,short-term postoperative insulin intensive treatment is helpful to the recovery of pancreatic islet function,reducing the inflammatory response and incidence of infection.