脓毒症早期胰岛素强化治疗对血清促炎症因子/抗炎症因子水平的影响及疗效观察  

Influence and efficacy of early intensive insulin treatment on serum proinflammatory/anti-inflammatory factor levels in metastasizing septicemia

作　　者：郑锦德 

机构地区：[1]仙居县人民医院急诊科,浙江仙居317300

出　　处：《中国微生态学杂志》2015年第1期86-88,91,共4页Chinese Journal of Microecology

摘　　要：目的探讨脓毒症早期胰岛素强化治疗对血清促炎症因子/抗炎症因子水平的影响及疗效观察。方法选取住院治疗的脓毒症患者64例,采用随机数字表将其分为研究组和对照组,每组32例。两组患者入院后立即予以抗感染、营养支持、维持水电解质酸碱平衡及治疗基础疾病等常规治疗。研究组在此治疗基础上按Hirsch推荐方法予以胰岛素持续泵入治疗,在24 h内使血糖维持在4.4~6.1 mmol/L;常规组患者在此治疗基础上予以常规使用胰岛素治疗,在24 h内使血糖维持在10.0~11.1 mmol/L。观察两组患者治疗前和治疗4 d后血清IL-1、IL-6和IL-10水平的变化,并比较其抗生素使用时间、住院时间、MODS发病率及病死率。结果治疗4 d后,两组患者血清IL-1和IL-6水平较前明显下降,血清IL-10水平较前明显上升（P〈0.01或P〈0.05）,且研究组下降或上升值较常规组更明显（P〈0.05）;同时研究组患者抗生素使用时间、住院时间和MODS发病率明显少于常规组（P〈0.05）,两组患者的病死率比较差异无统计学意义（P〉0.05）。结论脓毒症患者早期胰岛素强化治疗的疗效明显优于传统的常规使用胰岛素治疗,能缩短抗生素使用时间和住院时间,降低MODS发病率,改善其预后,作用可能与其能降低血清促炎症因子IL-1和IL-6水平,提高抗炎症因子IL-10水平,纠正血清促炎症因子/抗炎症因子比例失调密切相关。Objective To discuss the influence and curative effect observation of early intensive insulin treatment on serum proinflammatory / anti-inflammatory factor levels in metastasizing septicemia. Methods 64 patients with metastasizing septicemia were selected and divided into research group and control group by table of random number,with 32 cases in either group. Both groups were immediately given basic treatment including anti-infection,nutrition support,maintenance of water electrolyte and acid-base balance,etc. The research group was additionally given insulin,by constant pumping in accordance with the method recommended by Hirsch,to maintain the blood sugar at 4. 4-6. 1 mmol / L within 24 hours,while the control group was additionally given insulin in ordinary method to maintain the blood sugar at 10. 0-11. 1 mmol / L. The changes of serum IL-1,6 and 10 levels of patients in both groups before and 4 days after treatment were observed,and the duration of antibiotic use,length of stay（ LOS）,morbidity and mortality rates due to multiple organ dysfunction syndrome（ MODS） were compared.Results After 4 days＇ treatment,the serum IL-1 and 6 levels of patients in both groups obviously declined,while the serum IL-10 level obviously rose（ P〈 0. 01 or P〈 0. 05）,with the declining or rising rates in research group much higher than those in control group（ P〈 0. 05）. The duration of antibiotic use,LOS,and MODS-related morbidity rate in research group were much less than those in control group（ P〈 0. 05）. There was no statistical difference in the mortality rates between two groups（ P〉 0. 05）. Conclusion Compared with conventional insulin medication,early intensive insulin treatment has better efficacy on metastasizing septicemia,which can shorten the duration of antibiotic use and LOS,reduce MODS-related morbidity rate and improve the prognosis. The mechanism of action may be associated with the adjustment of the imbalance of serum proinflammatory / anti-inflammatory factors.

关 键 词：脓毒症 胰岛素 早期强化治疗 促炎症因子 抗炎症因子 

分 类 号：R459.7[医药卫生—急诊医学]