连续静脉－静脉血液滤过联合血液灌流对重症患者胰岛素抵抗的临床研究  

Research of CVVH combined withhemoperfusion on insulin resistance in severe patients

作　　者：李正超[1] 张玮[1] 夏婧[1] 杨德兴[1] 钱传云[1] 

机构地区：[1]昆明医科大学第一附属医院急诊重症医学中心,云南 昆明650032

出　　处：《中国急救医学》2015年第10期911-915,共5页Chinese Journal of Critical Care Medicine

摘　　要：目的：观察连续静脉－静脉血液滤过（ CVVH）联合血液灌流对重症患者胰岛素抵抗（ IR）的影响，并探讨重症患者IR产生的可能机制。方法2013－01～2013－12我院急诊重症加强治疗中心（ EICU）需要进行CRRT治疗的患者共90例，随机平均分成CVVH组（对照组）和CVVH＋HP组（试验组）进行治疗。分别于上机前空腹、下机后第二天空腹时从静脉釆血，进行空腹血糖（FPG）、空腹胰岛－素（FIN）、白细胞介素（IL）－1、IL－6、IL －8和肿瘤坏死因子－α（ TNF－α）浓度测定；计算患者CRRT 治疗前、治疗后24 h葡萄糖输入量与胰岛素用量比值（ G／I）；采用稳态模型评估法（ HOMA）计算胰岛素抵抗指数（ HOMA－IR）。结果患者经治疗后试验组血糖、血胰岛素、HOMA－IR、IL－1、IL－6、IL－8、TNF－α均较对照组明显下降；试验组G／I较对照组明显升高，差异均有统计学意义（ P＜0．05）；IL－1、IL－6、IL－8、TNF－α与患者IR的产生有相关性。结论 CVVH＋HP模式对重症患者IR的改善比CVVH模式明确，可能与CVVH＋HP能更强地清除血液中炎性介质有关。Objective To research influence on hemoperfusion combined with Continuous Vein-Venous Hemofiltration and insulin resistance of severe patients , so as to explore the mechanism of insulin resistance in severe patients .Methods Totally 90 severe patients experienced CRRT in the emergency Intensive Care Unit of our hospital from January 2013 to December 2013 were enrolled into＆amp;nbsp;this study.The 90 severe patients were divided into CVVH ＋HP group（experimental group） and CVVH group（control group ） stochastic and equally.Fasting blood glucose （ FPG）, fasting insulin （ FIN） interieukin-1（IL-1）,interieukin -6（IL-6）,interieukin -8（IL-8） and tumor necrosis factor -alpha（TNF-α） were measured, The ratio of total glucose input and insulin use （G/I） was computed before CRRT and 24 h after CRRT.And glucose amount resistance index （ HOMA-IR） calculated using Homeostasis Model Assessment （ HOMA ） before and after CRRT treatment .Results The levels of FPG,Fin,HOMA-IR, IL-1,IL-6,IL-8 and TNF-αof CVVH＋HP group were lower than CVVH group, G/I higher than CVVH group.The difference was significant（P〈0.05）.IL-1, IL-6, IL-8 and TNF-αare associated with insulin resistance in severe patients .Conclusion Efficacy of CVVH＋HP mode about insulin resistance in severe patients is more effective than CVVH group , Its mechanism may be associated with eliminated excessive inflammatory mediators .

关 键 词：连续静脉-静脉血液滤过(CVVH) 血液灌流 胰岛素抵抗(IR) 

分 类 号：R459.5[医药卫生—治疗学]