胰岛素强化治疗对严重创伤预后影响及其机制的探讨  

Investigation of Effect of Intensive Insulin Therapy on Prognosis and Mechanism in Patients with Severe Trauma

作　　者：冯刚[1] 曹帆帆[1] 姚峪岚 罗前程[1] 庄平[1] 金娴[1] 郭恩伟[1] 宋琼[1] 

机构地区：[1]第二军医大学公利临床医学院,200135

出　　处：《岭南急诊医学杂志》2014年第1期44-47,共4页Lingnan Journal of Emergency Medicine

基　　金：上海市浦东新区社会发展局卫生科技项目(2007A-10)

摘　　要：目的:探讨胰岛素强化治疗(IIT)对严重创伤预后影响及其机制。方法:将41例严重创伤伴应急性高血糖患者随机分为常规治疗(CT)组(n=21)和IIT组(n=20),两组均予以创伤常规治疗,CT组静脉注射常规胰岛素(RI)将血糖控制在10-11.1mmol/L;IIT组将血糖控制在4.4-6.1mmol/L。比较两组治疗前、治疗后24h、48 h、72 h、1周血浆TNF-α、IL-10、外周血多形核中性粒细胞(PMNs)凋亡率,APACHⅡ评分,住院期间病死率。结果:IIT组治疗后24 h、48 h、72 h、1周血浆TNF-α、IL-10水平,1周时APACHⅡ评分、住院期间病死率均明显低于CT组(P均<0.05);ⅡT组治疗后48 h、72 h及1周时外周PMNs凋亡率显著高于CT组(P均<0.01)。结论:IIT可改善严重创伤病人的预后,其作用机制除了降低应激性高血糖的直接毒性作用外,还可能通过促进严重创伤后PMNs凋亡,降低血浆促炎细胞因子,调节过度的炎症反应。Objective： To investigate the effect of intensive insulin therapy（IIT） on prognosis and mechanism in patients with severe trauma. Methods： 41 patients with severe trauma were randomly divided into conventional therapy （CT） group（n = 21） and IIT group（n = 20）. Besides routine treatment of trauma , the two groups was treated with intravenous insulin, the blood glucose of CT group and lIT group was controlled to 10-11.1 mmol/L and 4.4-6.1 mmol/L respectively. Serum TNF-ct, IL-10, the apoptosis rate of peripheral polymorphonuclear neutrophils （PMNs）, APACHE ]I score before and after treatment 24 h,48 h,72 h and 1 week,the mortality during in-hospital were compared between the two groups. Results： The serum TNF-ct and IL-10 after treatment 24 h, 48 h, 72 h, 1 week and APACHE 11 score after treatment 1 week and mortality during hospitalization were significantly lower in IIT group than those in CT group, all P 〈 0.05.The apoptosis rate of peripheral PMNs after treatment 48 h, 72 h and 1 week were significantly higher in IIT group than those in CT group, all P 〈 0.01. Conclusion： IIT can improve prognosis of severe trauma by facilitating apoptosis of peripheral PMNs,dccreasing serum proinflammatory cytokines and modulating excessive inflammatory response besides decreasing the toxic effects of stress hyperglycemia in patients with severe trauma.

关 键 词：胰岛素强化治疗 中性粒细胞 凋亡 创伤 预后 

分 类 号：R641[医药卫生—外科学]