胰岛素／葡萄糖-胰岛素-钾干预对严重烧伤早期的影响

目的了解胰岛素／葡萄糖-胰岛素-钾（GIK）干预治疗对严重烧伤患者早期的影响。方法回顾性分析青岛市立医院烧伤整形科2008年7月至2010年7月收治的资料较完整的58例大面积烧伤住院患者。依据入院后是否给予胰岛素／GIK干预治疗将58例患者分为胰岛素／GIK干预组（30例）和对照组（28例），胰岛素／GIK干预组患者入院后给予胰岛素／GIK干预治疗，对照组按临床常规治疗。治疗后1、3、5、7、9d晨抽取两组患者的静脉血，检测血浆血糖、血脂、蛋白质代谢以及心肝功能水平、凝血等各项指标。观察应激性糖尿病及脓毒症的发生。结果胰岛素／GIK干预组应激性糖尿病及脓毒症发生明显低于对照组（P〈0．05）。胰岛素／GIK干预组前白蛋白（PA）在伤后第7天较对照组升高（P〈0．05）；甘油三脂（TG）在伤后第5天较对照组降低（P〈0．05）；高密度脂蛋白（HDL）在伤后第5天较对照组升高（P〈0．05）；乳酸脱氢酶（LDH）、a-羟丁酸脱氢酶（a—HBDH）、肌酸激酶同工酶（CK—MB）较对照组分别在第5、7、9天降低（P〈0．05）；丙氨酸转氨酶（ALT）、γ-谷氨酰转肽酶（γ—GT）在伤后第9天较对照组降低（P〈0．05）；活化部分凝血活酶时间（APlT）、凝血酶原时间（PT）在伤后第5天较对照组降低；纤维蛋白原（FBG）伤后第5天较对照组增加（P〈0．05）。结论严重烧伤后行胰岛素／GIK干预治疗，可以减少应激性糖尿病的发生，对脂代谢、蛋白质代谢产生一定的影响，改善心、肝功能，减弱烧伤患者的炎性介质反应。

Effect of early insulin/glucose-insulin-potassium treatment on severely burned patients

Objective To investigate the effect of early insulin/glucose-insulin-potassium （GIK） treatment on severely burned patients. Methods The clinical data were collected from 58 severely burned patients who were treated in the Qingdao Municipal Hospital during 2008 to 2010. All the 58 patients were divided into two groups, insulin/GIK treatment group （T group） and control group （C group）. The patients in T group had been administered with insufin/GIK, while the patients in C group had not. The dynamic changes in blood glucose, prealbumin （PA） , triglyceride （TG）, high density lipoprotein （HDL）, creatine kinase isoenzyme （ CK-MB ）, lactate dehydrogenase （ LDH ）, a-hydroxybutyrate dehydrogenase （ a-HB- DH）, alanine aminotransferase （ALT）,γ-glutamyl transpeptidase （T- GT）, activated partial thromboplas- tin time （APTT）, prothrombin time （PT）, thrombintime （TT）, fibrinogen （FBG） on the 1, 3, 5, 7, 9 days in two groups of burn patients were analyzed and compared. Results Stress diabetes and sepsis in T group were lower than in C group （ P 〈 0.05 ）. The levels of PA on 7 post burn days （PBD） in T group were higher than in C group （ P 〈 0.05 ）. The levels of TG on 5 PBD in T group were lower than in C group （ P 〈 0.05 ）. The levels of HDL on 5 PBD in T group were higher than in C group （ P 〈 0.05 ）. The levels of LDH, a-HBDH, CK-MB on 5, 7, 9 PBD in T group were lower than in C group （P 〈 0.05）. The levels of ALT and γ-GT on 9 PBD in T group were lower than in C group （ P 〈 0.05 ）. The levels of APTT and PT on 5 PBD in T group were lower than in C group （ P 〈 O. 05 ）. The levels of FBG on 5 PBD in T group were higher than in C group （ P 〈 O. 05 ）. Conclusions Insulin/＇GIK treatment group can mitigate systemic in- flammatory response and stress diabetes with severe bums. The excellent metabolic control in glucose and improvement of lipids and protein metabolism can be achieved, and a protective effect on liver and heart presented.