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目的探讨烧伤后早期强化胰岛素治疗对脓毒症合并高血糖患者体内过度炎性反应、脓毒症的发生、发展、并发症的出现及其预后的影响。方法依据治疗方法的不同将40例患者分成常规组和强化组。脓毒症并发高血糖期间胰岛素持续泵入,其中常规组血糖(BS)维持在10.1～11.1 mmol/L,强化组为4.4～6.1 mmol/L,同时监测两组患者血清中TNF-α、IL-6、IL-18和CRP等炎性介质及前白蛋白(PA)、尿素氮(BUN)的水平,并对脓毒症引起的并发症及死亡率进行分析。结果强化组于治疗后10、14、21 d,血清中TNF-α、IL-6、IL-18、CRP和BUN水平明显低于常规组(P<0.05),而PA明显高于常规组(P<0.05)。强化组脓毒症的预后明显优于常规组。结论烧伤后早期强化胰岛素治疗减缓了脓毒症的进一步发生、发展,从而减少并发症的发生,降低了死亡率。
Objective To investigate the effects of early intensive insulin therapy on the occurrence and development of sepsis, the occurrence of complications and prognosis in septic patients with hyperglycemia. Methods According to the different treatment methods, 40 patients were divided into routine group and intensive group. During continuous sepsis and hyperglycemia, insulin was pumped continuously. The blood glucose (BS) was maintained at 10.1-11.1 mmol / L in the conventional group and 4.4-6.1 mmol / L in the intensive group. The levels of TNF-α, IL -6, IL-18 and CRP and other inflammatory mediators and pre-albumin (PA), blood urea nitrogen (BUN) levels, and sepsis-induced complications and mortality were analyzed. Results The levels of TNF-α, IL-6, IL-18, CRP and BUN in the intensive group at 10, 14 and 21 d after treatment were significantly lower than those in the conventional group (P <0.05) P <0.05). Fortified group sepsis prognosis was significantly better than the conventional group. Conclusions Intensive insulin therapy in the early postburn phase slows down the occurrence and development of sepsis, thus reducing the incidence of complications and reducing the mortality rate.