不同血糖控制水平对PICU脓毒症患儿炎性反应状态和治疗效果的影响

目的 探讨不同血糖控制水平对PICU脓毒症患儿炎性反应状态和治疗效果的影响.方法 选取2014年1月至2016年1月PICU收治的脓毒症患儿63例,依据随机数字表法将患者分为A组、B组和C组,每组21例.A组患儿控制目标血糖值于4.4~6.1 mmol/L,B组患儿控制目标血糖值于6.2~8.3 mmol/L,C组患儿控制目标血糖值于8.4~10.0 mmol/L,观察比较3组患儿炎性反应状态和治疗效果.结果 入PICU后1 d、3 d,A组肿瘤坏死因子-α(TNF-α)水平均明显低于B组和C组,入PICU后7 d,A组和B组TNF-α水平明显低于C组,差异有统计学意义(P<0.05);入PICU后1 d,A组IL-4水平均明显高于B组和C组,入PICU后3 d,A组IL-4水平明显低于B组和C组,差异有统计学意义(P<0.05);入PICU后3 d和7 d,A组Wnt5a水平均明显低于B组和C组,差异有统计学意义(P<0.05);A组患儿病死率和MODS发生率低于B组和C组,但差异无统计学意义(P>0.05);3组患儿PICU治疗时间差异有统计学意义(P<0.05);3组患儿低血糖发生率差异无统计学意义(P>0.05).结论 血糖水平控制于4.4~6.1 mmol/L,有助于抑制脓毒症患儿体内TNF-α和Wnt5a促炎介质的释放,刺激IL-4生成,降低患儿炎性反应,同时还能提高患儿治疗效果,值得推广应用.

Effects of different levels of blood glucose on inflammation reaction status and therapeutic effects in PICU in children patients with sepsis

Objective To investigater the effects of different levels of blood glucose on inflammation reaction status and therapeutic effects in pediatric intensive care unit (PICU) in children patients with sepsis.Methods Sixty-three children patients with sepsis who were admitted and treated in PICU of our hospital from January 2014 to January 2016 were divided into group A,group B,group C according to random number table,with 21 patients in each group.The blood glucose levels in group A were controlled in 4.4~6.1mmol/L,and 6.2~8.3mmol/L in group B, 8.4~10.0mmol/L in group C.The inflammation reaction status and therapeutic effects were observed and compared among the three groups.Results On 1 day and 3 days after put into PICU,the serum levels of TNF-αin group A were significantly lower than those in group B and group C (P<0.05).On 1 day after put into PICU,the serum levels of IL-4 in group A were significantly higher than those in group B and group C,however, on 3 days after put into PICU,the serum levels of IL-4 in group A were significantly lower than those in group B and group C (P<0.05).On 3 days and 7 days after put into PICU,the serum levels of Wnt5a in group A were significantly lower than those in group B and group C (P<0.05).The case fatality rate and incidence rate of MODS in group A were lower than those in group B and group C,but there were no significant differences among them (P>0.05).There was significant difference in treatment time in PICU among three groups (P<0.05), however, there were no significant differences in incidence rates of hypoglycemia among three groups (P>0.05).Conclusion The blood glucose levels controlled in 4.4~6.1mmol/L help to inhibit the release of TNF-α and Wnt5a in children patients with sepsis,to stimulate IL-4 production,reduce inflammation reaction and improve therapeutic effect, therefor,which is worth using widely in clinical practice.