醒脑静注射液、胰岛素泵联合减压术治疗重型颅脑损伤合并糖尿病的临床疗效

Xingnaojing injection and insulin pump combined with decompression in treatment of severe craniocerebral injury with diabetes mellitus

目的探讨醒脑静注射液、胰岛素泵联合减压术治疗重型颅脑损伤(severe craniocerebral injury,STBI)合并糖尿病的临床疗效及对不良反应的影响。方法前瞻性分析烟台市烟台山医院外科重症监护病房于2017年1月至2020年1月期间收治的STBI合并糖尿病患者102例,男性,平均年龄(48.27±4.20)岁。将其依循双盲随机法划分为A组(34例,采用单纯减压术治疗),B组(34例,采用胰岛素泵联合减压术治疗)与C组(34例,采用醒脑静注射液、胰岛素泵联合减压术方式)。比较三组空腹血糖(fasting blood glucose,FPG)、餐后2 h血糖水平(2 h postprandial blood glucose level,2hPG)、白细胞介素2(interleukin 2,IL-2)、白细胞介素6(interleukin,IL-6)与血清超敏C反应蛋白(serum high sensitivity C-reactive protein,hs-CRP)、格拉斯哥昏迷评分表(glasgow coma scale,GCS)差异,并记录不良反应发生率。用SPSS 23.0统计学软件进行数据处理,计量资料采用均数±标准差(±s),采用t检验,计数资料以(%)表示,采用χ2检验。结果治疗后A组、B组2hPG、FPG、IL-2、IL-6、hs-CRP、GCS评分对比,差异无统计学意义(P>0.05)。治疗后,C组2hPG、FPG分别为(8.89±1.74)、(7.53±1.59)mmol/L,A组、B组分别为(7.30±1.62)、(6.25±1.50)mmol/L和(7.32±1.64)、(6.29±1.56)mmol/L,C组水平较A组、B组更高,差异有统计学意义(P<0.05)。C组IL-2、IL-6、hs-CRP水平分别为(792.74±86.58)ng/L、(8.82±1.73)ng/L、(7.95±1.44)mg/L,A组、B组这三项指标分别为(880.85±90.29)ng/L、(13.85±2.20)ng/L、(14.02±2.28)mg/L;(875.37±89.72)ng/L、(13.34±2.18)ng/L、(13.37±2.26)mg/L,C组较A组、B组更低,差异有统计学意义(P<0.05)。C组GCS评分为(11.45±2.23)分,A组、B组分别为(8.09±1.52)分、(8.73±1.56)分,C组较A组、B组更高,差异有统计学意义(P<0.05)。与A组、B组相比,C组不良反应发生率更低,差异有统计学意义(P<0.05)。结论醒脑静注射液、胰岛素泵联合减压术治疗STBI合并糖尿病患者,对于降低不良反应,提高治疗安全性等具有重要意义。

Objective To investigate the clinical efficacy and adverse reactions of Xingnaojing injection combined with insulin pump in treatment of severe craniocerebral injury(STBI)complicated with diabetes mellitus.Methods Data of 102 patients with STBI combined with diabetes mellitus admitted from Jan.2017 to Jan.2020 in the Surgical Intensive Care Unit of Yantaishan Hospital were prospectively analyzed.Their average age was(48.27±4.20)years.They were randomly divided into group A(34 cases,treated with simple decompression),group B(34 cases,treated with insulin pump combined decompression)and group C(34 cases,treated with Xingnaojing injection and insulin pump combined decompression).Fasting blood glucose(FPG),2 h postprandial blood glucose level(2 h PG),interleukin 2(IL-2),interleukin 6(IL-6),serum high sensitivity C-reactive protein(hs CRP)and glasgow coma scale(GCS)was different,and the incidence of adverse reactions was recorded.SPSS 23.0 statistical software was used for data processing.The measurement data were mean±standard deviation,and t test was used;the counting data were expressed in(%)andχ2 inspection was used.Results After treatment,there was no significant difference in 2 h PG,FPG,IL-2,IL-6,hs CRP or GCS scores between group A and group B(P>0.05).After treatment,the levels of 2 h PG and FPG were(8.89±1.74)mmol/L and(7.53±1.59)mmol/L in group C,(7.30±1.62)mmol/L and(6.25±1.50)mmol/L in group A,(7.32±1.64)mmol/L and(6.29±1.56)mmol/L in group B.The levels in group C were higher than those in group A and group B(P<0.05).The levels of IL-2,IL-6 and hs CRP in group C were(792.74±86.58)ng/L,(8.82±1.73)ng/L and(7.95±1.44)mg/L respectively.The three indexes were(880.85±90.29)ng/L,(13.85±2.20)ng/L and(14.02±2.28)mg/L respectively in group A;(875.37±89.72)ng/L,(13.34±2.18)ng/L,and(13.37±2.26)mg/L respectively in group B.Group C was lower than group A and group B(P<0.05).The GCS score of group C was 11.45±2.23(points),and that of group A and group B were 8.09±1.52(points)and 8.73±1.56(points)respectively.Group C was higher than that of group A and group B(P<0.05).Compared with group A and group B,the incidence of adverse reactions in group C was lower,and the difference was statistically significant(P<0.05).Conclusion Xingnaojing injection and insulin pump combined with decompression are of great significance in reducing adverse reactions and improving the safety of clinical treatment.