胰岛素强化治疗对重度烧伤并发应激性高血糖老年患者早期认知功能及预后的影响

目的探讨胰岛素强化治疗对重度烧伤并发应激性高血糖老年患者早期认知功能、血清神经元特异性烯醇化酶(NSE)、S100β含量和预后的影响。方法 80例重度烧伤并发应激性高血糖老年患者,按随机数字表法分为强化组(40例)和常规组(40例),强化组患者入院后即行胰岛素强化治疗,将血糖水平控制在6.0~8.0mmol/L,常规组患者入院后予以临床常规治疗,胰岛素控制血糖水平在8.1~10.0mmol/L。分别于入院即时(T0),治疗开始第1天(T1)、第2天(T2)、第3天(T3)、第5天(T4)和第7天(T5)测定简易精神状态量表(MMSE)评分、评价认知功能障碍的发生率,并检测血清NSE和S100β含量。观察两组患者多器官功能衰竭综合征(MODS)、脓毒症、低血糖发生率及病死率。结果治疗第2~7天,强化组MMSE评分显著高于相应时间点常规组,认知功能障碍发生率、血清NSE和S100β含量明显低于常规组(P0.05)。与入院即时比较,常规组和强化组分别从治疗第5~7天和第2~7天MMSE评分升高,认知功能障碍发生率和血清NSE、S100β含量下降(P0.05)。与常规组比较,强化组治疗近期MODS及脓毒症发生率显著下降(P0.05),低血糖发生率及病死率组间比较差异无统计学意义(P0.05)。结论胰岛素强化治疗可以改善重度烧伤老年患者早期认知功能,减少MODS和脓毒症发生率,降低患者血清NSE和S100β含量。

Effects of insulin intensive therapy on early cognitive function and prognosis of elderly patients with severe burn complicated with stress hyperglycemia

Objective To investigate the effects of insulin intensive therapy on early cognitive function, contents of NSE and S100βand prognosis of elderly patients with severe burn complicated with stress hyperglycemi-a.Methods Eighty elderly patients with severe burn complicated with stress hyperglycemia were randomly divided into intensive group( n=40) and conventional group( n=40) .Insulin intensive therapy was given to the patients in the intensive group to maintain blood glucose level at 6.0-8.0mmol/L ofter admission.Blood glucose level of pa-tients in the conventional group was maintained at 8.1-10.0mmol/L under routine clinical treatment.MMSE( mini-mental state examination) score and the incidence rate of cognitive dysfunction were measured at the time of admis-sion(T0) and at 1d(T1),2d(T2),3d(T3),5d(T4),7d(T5) after treatment.Also,the serum contents of NSE and S100βwere determined at the same time as before.The incidence rates of MODS,sepsis,hypoglycemia and death were recorded in the two groups.Results MMSE scores in the intensive group were higher,while the incidence rates of cognitive dysfunction and the serum contents of NSE and S100βwere lower than those of the conventional group from T2-T5(P<0.05).Compared with T0,MMSE scores in the intensive group and conventional group were increased at T2-T5 and at T4-T5 respectively,while cognitive dysfunction and the serum contents of NSE and S100βwere decreased(P<0.05).Incidence rate of MODS and sepsis were obviously lower in the intensive group than the conventional group after insulin intensive therapy. Conclusion Insulin intensive therapy can improve cognitive function,reduce incidence rates of MODS and sepsis,and decrease serum contents of NSE and S100βof elderly pa-tients with severe burn complicated with stress hyperglycemia.