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目的探讨严格血糖控制对脓毒症患者左心功能及C-反应蛋白影响。方法选择伴有心功能不全的严重脓毒症和脓毒症休克患者60例,随机分为常规组(28例)和目标组(32例)。通过静脉持续输注胰岛素和加强血糖监测将平均血糖控制在目标组4.0～6.1mmol/L,常规组6.2～8.3mmol/L。采用多普勒超声心动图测定左室心功能,并用乳胶免疫增强比浊发法测定高敏CRP水平。结果 72h后与常规组比较,目标组平均血糖水平下降[(6.0±1.7)mmol/L对(8.2±2.2)mmol/L,P<0.05)]、胰岛素用量增加[(11.3±2.7)U/h对(8.5±2.4)U/h,P<0.05]。左室射血分数(LVEF)、E/A、分别增加15.2%、26%;CRP下降20.3%(P<0.05)。常规组相和目标组严重低血糖发生率分别为17.8%和18.7%,两组比较无统计学差异(P>0.05)。结论严格血糖控制可改善伴有心功能不全的严重脓毒症和脓毒症休克患者左室收缩和舒张功能,减轻心功能受损。
Objective To investigate the effect of strict glycemic control on left ventricular function and C-reactive protein in septic patients. Methods Sixty patients with severe sepsis and septic shock accompanied by cardiac insufficiency were randomly divided into routine group (n = 28) and target group (n = 32). Continuous intravenous infusion of insulin and blood glucose monitoring will be the average glycemic control in the target group 4.0 ~ 6.1mmol / L, conventional group 6.2 ~ 8.3mmol / L. Left ventricular function was measured by Doppler echocardiography, and high-sensitivity CRP levels were measured by latex immunopotentiation turbidimetry. Results Compared with the control group, the average blood glucose level of the target group decreased significantly after 72 hours ([(6.0 ± 1.7) mmol / L vs 8.2 ± 2.2 mmol / L, P <0.05) h vs (8.5 ± 2.4) U / h, P <0.05]. Left ventricular ejection fraction (LVEF), E / A, increased by 15.2%, 26%; CRP decreased by 20.3% (P <0.05). The incidences of severe hypoglycemia in routine group and target group were 17.8% and 18.7% respectively, with no significant difference between the two groups (P> 0.05). Conclusions Strict glycemic control can improve left ventricular systolic and diastolic function and reduce impaired cardiac function in patients with severe sepsis and septic shock accompanied by cardiac insufficiency.