胰岛素强化治疗对严重创伤患者炎性反应及预后的影响

目的 了解胰岛素强化治疗对严重创伤患者炎性反应及预后的影响.方法 将80例严重创伤患者按随机配对原则分为治疗组(40例)和对照组(40例).治疗组患者入院后立即行胰岛素强化治疗,从胰岛素泵泵入胰岛素2～4 U/h,控制血糖值在6～8 mmol/L;对照组按临床常规治疗,不给予胰岛素.观察2组患者的发热、器官损伤情况,统计病死率.于开始治疗后1、3、5、7 d晨抽取2组患者静脉血,检测血浆TNF-α、IL-2、IL-10、C反应蛋白(CRP)水平.结果 治疗组患者9例发生高热,低于对照组(29例).治疗组和对照组各有31例和30例患者出现1个脏器功能不全.治疗组和对照组同一患者出现3个脏器功能不全的分别为10、19例,出现4个脏器功能不全的分别为7、12例.治疗组伤后3 d内死亡4例,3 d以后死亡1例,病死率为12.5%;对照组伤后3 d内死亡5例,3 d以后死亡4例,病死率为22.5%.治疗后3～7 d,治疗组患者TNF-α、CRP值均低于对照组(P<0.05或P<0.01),而IL-2、IL-10值则均高于对照组(P<0.05或P<0.01).治疗后7 d,治疗组TNF-α、CRP值最低,分别为(1.3±0.6)μg/L、(55±16)mg/L,且明显低于对照组的(3.0±0.8)μg/L、(89±20)mg/L(P<0.01).结论 严重创伤后行胰岛素强化治疗,可以减轻患者全身性炎性反应程度,改善创伤患者预后.

Effects of intensive insulin therapy on inflammatory response and prognosis of patients with severe trauma

Objective To investigate the effects of intensive insulin therapy on inflammatory re-sponse and prognosis of patients with severe trauma. Methods Eighty severely injured patients were di-vided into intensive insulin therapy group (n = 40, IT) and routine therapy group (n = 40, RT) in random pair. At the time of admission, a continuous infusion of insulin (2 -4 U/h) was pumped into the patients of IT group to maintain blood glucose level at 6 -8 mmol/L. Patients in RT group were given routine treatment without administration of insulin. Fever, organ injury, and mortality of patients in 2 groups were recorded. Venous blood was drawn from patients of 2 groups on the morning of post treatment day (PTD) 1, 3, 5, and 7. Values of TNF-α, C-reactive protein (CRP), IL-2, and IL-10 in plasma were assayed. Results High fever appeared in 9 patients in IT group, and WBC exceeded 10.0×109 for more than 3 days in 17 patients in this group, versus 20 and 29 patients respectively in RT group. Dysfunction of 1 organ appeared in 31 pa-tients in IT group and 30 patients in RT group. Dysfunction of 3 organs appeared in 10 patients in IT group and 19 patients in RT group. Dysfunction of 4 organs appeared in 7 patients in IT group and 12 patients in RT group. In IT group, 4 patients died within 3 post-injury day (PID), and 1 patient died after PID 3 (total case fatality: 12.5% ). In RT group, 5 patients died within 3 PID, and 4 patient died after PID 3 (total case fatality: 22.5%). Plasma levels of TNF-α and CRP of patients in IT group were significantly lower than those of patients in RT group on PID 3 - 7 ( P<0.05 or P<0.01 ), while levels of IL-2 and IL-10 of patients in IT group were significantly higher than those of patients in RT group ( P<0.05 or P<0.01 ). Plasma levels of TNF-α ( 1.3±0.6 μg/L) and CRP (55±16 mg/L) of patients in IT group on PTD 7 were lowered to the trough level, and they were significantly lower than those of patients in RT group (3.0±0.8μg/L, 89±20 mg/L, respectively, P <0.01 ). Conclusions Intensive insulin therapy can mitigate systemic inflammatory response and improve prognosis of patients with severe trauma.