实时动态血糖监测及调节对脓毒症患者血清炎症因子水平及预后的影响  

Effect of real-time continuous monitoring system on serum inflammatory factors and prognosis in patients with sepsis

作　　者：李萌[1] 姚莉[1] 纪小奇[1] 陈城[1] 崔静[1] 赵晶晶[1] 伍银银 Li Meng;Yao Li;Ji Xiaoqi;Chen Cheng;Cui Jing;Zhao Jingjing;Wu Yinyin(Department of Critical Care Medicine, the Second People’s Hospital of Hefei, Hefei 230000, China)

机构地区：[1]合肥市第二人民医院重症医学科,230000

出　　处：《中华内分泌外科杂志》2019年第3期245-248,共4页Chinese Journal of Endocrine Surgery

基　　金：合肥市科技攻关计划资助项目(合科[2017]3-54).

摘　　要：目的探讨实时动态血糖监测系统对脓毒症患者血清炎症因子水平及预后的影响。方法采用前瞻性研究将入选脓毒症患者根据随机数字表法随机分为两组,分别为实时动态血糖监测组及血糖仪监测组,在第1、3、7天分别检测两组空腹血清肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、超敏C反应蛋白(hs-CRP),记录两组胰岛素用量,低血糖发生率及28天病死率,并对上述指标进行分析。结果实时动态血糖监测组第7天TNF-α、IL-6、hs-CRP分别为(16.12±2.42)pg/ml、(112.37±17.39)pg/ml、(19.62±2.72)mg/L,血糖仪监测组第7天TNF-α、IL-6、hs-CRP分别为(23.46±3.12)pg/ml、(140.19±21.48)pg/ml、(25.42±2.54)mg/L,动态血糖监测组较血糖仪监测组TNF-α、IL-6、hs-CRP下降更明显,差异有统计学意义(P<0.05)。实时动态血糖监测组胰岛素用量为(90.62±15.79)u,低血糖发生率5.4%,住院28 d病死率10.81%,血糖仪监测组胰岛素用量为(130.59±20.65)u,低血糖发生率22.85%,住院28 d病死率31.42%,两组比较差异有统计学意义(P<0.05)。结论对于存在应激性高血糖的脓毒症患者,实时动态血糖监测系统结合胰岛素治疗可改善患者炎症反应,更好的控制血糖,降低病死率。Objective To investigate the effect of real-time continuous monitoring system (RT-CGMS) on serum inflammatory factors and prognosis in patients with sepsis. Methods According to the prospective studies, patients were randomly divided into two groups Patients with sepsis were randomly divided into real-time continuous monitoring of blood glucose group and monitoring blood glucose meter group, of which the fasting serum tumor necrosis factor alpha (TNF-α) and interleukin-6 (IL-6) and high sensitive C reactive protein (hs-CRP) were detected on the 1st, 3rd, 7th day. Meanwhile, insulin dosage, incidence of hypoglycemia and mortality rate of 28 days of patients in two groups were recorded, and the above indexes were analyzed. Results TNF-α, IL-6 and hs-CRP in the real-time continuous blood glucose monitoring group were (16.12±2.42) pg/ml、(112.37±17.39) pg/ml and (19.62±2.72) mg/L on the 7th day respectively, while TNF-α, IL-6 and hs-CRP in the blood glucose monitoring group were (23.46±3.12) pg/ml、(140.19±21.48) pg/ml and (25.42±2.54) mg/L on the 7th day, respectively. The decrease of TNF-α, IL-6 and hs-CRP in the continuous blood glucose monitoring group was more significant than that in the blood glucose monitoring group (P<0.05). Insulin dosage in real-time continuous blood glucose monitoring group was (90.62±15.79) u, hypoglycemia rate was 5.4%, fatality rate was 10.81% in 28 days of hospitalization, insulin dosage was (130.59±20.65) u, hypoglycemia rate was 22.85%, and fatality rate was 31.42% in 28 days of hospitalization. There was significant difference between the two groups (P<0.05). Conclusion For sepsis patients with stress hyperglycemia, a real-time continuous monitoring system combined with insulin therapy can improve the inflammatory response, and control blood glucose effectively as well as reduce mortality.

关 键 词：实时动态血糖监测系统 脓毒症 炎症因子 

分 类 号：R459.7[医药卫生—急诊医学]