强化胰岛素在大面积烧伤休克复苏过程中的应用研究

目的探讨强化胰岛素对大面积烧伤休克患者复苏过程的治疗效果。方法纳入我院2008年1月至2014年10月收治的老年大面积烧伤休克患者84例,男63例,女21例,烧伤总面积为30%~91%(48%±10.2%)TBSA,Ⅲ度面积为15%~45%(26%±10%)TBSA。将其随机分为治疗组和对照组,每组42例。两组患者均给予常规的烧伤治疗,在此基础上,对照组给予短效胰岛素,治疗组给予强化胰岛素,疗程均为7 d。记录治疗前后所有患者的空腹血糖(FPG)、餐后2 h血糖(2hPG)、糖化血红蛋白(HbA1c)、空腹胰岛素(FINS)、稳态模型胰岛素抵抗指数(HOMA-IR)、白介素6(IL-6)、肿瘤坏死因子α(TNF-α)、分泌型卷曲相关蛋白5(SFRP5)水平,检测血清尿素氮(BUN)水平、血肌酐(Cr)水平的变化情况及预后。结果治疗前,两组各指标基线水平比较差异无统计学意义(P>0.05)。治疗后,两组FPG、2hPG、HbA1c、BMI、FINS、HOMA-IR、TNF-α、IL-6水平均下降(P<0.05),SFRP5水平升高(P<0.05),且治疗组各项指标改善更明显(P<0.05);治疗3 d,两组Cr水平、病死率比较差异有统计学意义(P<0.05),两组BUN水平比较差异无统计学意义(P>0.05)。结论强化胰岛素不仅可调节2型糖尿病患者的糖脂代谢,还通过影响IL-6、TNF-α、SFRP5等脂肪因子改善胰岛素抵抗,降低应激状态下的高分解代谢,降低病死率。

Application study on intensive insulin in the shock recovery of extensive burn

Objective To investigate the effect of intensive insulin on the recovery process of patients with ex-tensive burn shock. Methods Eighty-four patients with extensive burn shock in our hospital from January 2008 to Oc-tober 2014 were included. The total burn area was 30% ~91% ( 48% ± 10. 2%) TBSA,Ⅲ degree area was 15% ~45% (26% ± 10%) TBSA. All the patients were randomly divided into treatment group and control group. Patients were given conventional treatment for burns;besides,patients in control group (n=42) received a short-acting insulin, and patients in treatment group (n=42) received intensive insulin,the course lasting for 7 d. The fasting plasma glu-cose (FPG),2 h postprandial blood glucose (2hPG),glycated hemoglobin (HbA1c),fasting insulin (FINS),homeo-stasis model insulin resistance index (HOMA-IR),the levels of interleukin-6 (IL-6),tumor necrosis factor-α (TNF-α),secreted frizzled-related protein 5 (SFRP5),serum urea nitrogen (BUN) and creatinine (Cr) and the prognosis were recorded before and after treatment. Results There was no significant difference in the baseline indexes between the two groups (P>0. 05). The FPG,2hPG,HbA1c,BMI,FINS,HOMA-IR,TNF-α and IL-6 levels of patients de-creased significantly (P<0. 05)after treatment:however,the SFRP5 increased (P<0. 05) after treatment,and the in-dexes in treatment group were improved more significantly than control group ( P <0. 05 ) . There were significant differences in Cr and mortality between the two groups ( P<0. 05 ) , while no obvious difference was found in BUN (P>0. 05) at 3 d after treatment. Conclusion Intensive insulin can not only regulate the glucose and lipid metabolism in patients with type 2 diabetes,but also affect IL-6,TNF-α,SFRP5 and other adipokines,thus improving insulin resist-ance,decreasing the high catabolic stress state and the mortality.