本文選題：連續(xù)靜脈-靜脈濾過(guò)　切入點(diǎn)：血液灌流　出處：《昆明醫(yī)科大學(xué)》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的研究組合血液凈化模式對(duì)MODS患者胰島素抵抗的臨床療效,探討改善MODS患者胰島素抵抗最佳血液凈化模式及闡明MODS患者出現(xiàn)胰島素抵抗的可能機(jī)制。方法選取MODS患者60例,隨機(jī)分為單一血液凈化模式(連續(xù)靜脈-靜脈血液濾過(guò))和組合式血液凈化模式組(連續(xù)靜脈-靜脈血液濾過(guò)+血液灌流),每組各30例,觀察兩組患者基本情況：年齡,性別,入院24小時(shí)內(nèi)APACHE Ⅱ評(píng)分,入院24小時(shí)內(nèi)SOFA評(píng)分,收集治療開(kāi)始前、治療后7 d臨床指標(biāo)變化情況:FBG(空腹血糖),HbA1c(糖化血紅蛋白),FINS(空腹胰島素),CRP (C-反應(yīng)蛋白),HOMA-IR(胰島素抵抗指數(shù)),BGSD (BG標(biāo)準(zhǔn)差),BGcv (BG變異系數(shù)),IL-1(白介素-1)、IL-6(白介素-6)、IL-8(白介素-8)、IFN-α(干擾素-α),根據(jù)治療后HOMA-IR(胰島素抵抗指數(shù))2.69把患者分成治療后胰島素抵抗組和治療后胰島素不抵抗組并比較兩組患者IL-1(白介素-1)、IL-6(白介素-6)、IL-8(白介素-8)、TNF-α(干擾素-α)是否有差異,采用Epidata 3.02軟件包數(shù)據(jù)錄入,采用雙錄入方法對(duì)試驗(yàn)數(shù)據(jù)進(jìn)行錄入,兩次數(shù)據(jù)核查無(wú)誤后,采用spss20.0統(tǒng)計(jì)學(xué)軟件包結(jié)合相關(guān)專業(yè)進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果1、經(jīng)兩獨(dú)立樣本t檢驗(yàn)：試驗(yàn)組和對(duì)照組年齡、APACHE Ⅱ評(píng)分、SOFA評(píng)分均無(wú)統(tǒng)計(jì)學(xué)差異(P0.05),經(jīng)四表格χ2檢驗(yàn)：試驗(yàn)組和對(duì)照組性別無(wú)統(tǒng)計(jì)學(xué)差異(P=0.301)：試驗(yàn)組和對(duì)照組治療前FBG(空腹血糖)、FINS(空腹胰島素)、HOMA-IR(胰島素抵抗指數(shù))、BGSD(空腹血糖標(biāo)準(zhǔn)差)、BGCV(口服血糖變異系數(shù)均無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)；試驗(yàn)組合對(duì)照組治療前IL-1(白介素-1)、IL-6(白介素-6)、IL-8(白介素-8)、IFN-α(干擾素-α)均無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。2、經(jīng)兩獨(dú)立樣本t檢驗(yàn)：試驗(yàn)組組和對(duì)照組治療后FINS(空腹胰島素)、CRP (C-反應(yīng)蛋白)、HOMA-IR(胰島素抵抗指數(shù))、FBG(空腹血糖)、BGsD(血糖標(biāo)準(zhǔn)誤)、BGCV(血糖變異系數(shù))、INS(普通胰島素用量)、IL-1(白介素-1)、IL-6(白介素-6)、IL-8(白介素-8)、IFN-α(干擾素-α)均有統(tǒng)計(jì)學(xué)差異(P0.05)。3、經(jīng)配對(duì)t檢驗(yàn)：試驗(yàn)組治療前后FINS(空腹胰島素)、HOMA-IR(血糖抵抗指數(shù))、CRP(C-反應(yīng)蛋白)、FBG(空腹血糖)、BGsD(血糖標(biāo)準(zhǔn)誤)、BGCV,(血糖變異系數(shù))、IMS(普通胰島素用量)、IL-1(白介素-1)、IL-6(白介素-6)、IL-8(白介素-8)、TNF-α(干擾素-a)均有統(tǒng)計(jì)學(xué)差異(P0.05)。4、經(jīng)兩獨(dú)立樣本t檢驗(yàn)：胰島素抵抗組和胰島素不抵抗組IL-1(白介素-1)、IL-6(白介素-6)、IL-8(白介素-8)、IFN-α(干擾素-α)均有統(tǒng)計(jì)學(xué)差異(P0.05)。5、經(jīng)簡(jiǎn)單線性相關(guān)分析：HOMA-Rl：胰島素抵抗指數(shù))和IL-1(白介素-1)有相關(guān)性(P0.001, r=0.637)、HOMA-R(胰島素抵抗指數(shù))和IL-6(白介素-6)有相關(guān)性(P0.001, r=0.664)、HOMA-Ri(胰島素抵抗指數(shù))和IL-8(白介素-8)有相關(guān)性(P0.001, r=0.574)、HOMA-R(胰島素抵抗指數(shù))和IFN-α(干擾素-α)有相關(guān)性(P0.001,r=0.844)。結(jié)論1、組合式血液凈化模式對(duì)MODS患者胰島素抵抗療效優(yōu)于單一血液凈化模式(CVVH)。2、組合式血液凈化模式對(duì)MODS患者血液中炎性介質(zhì)清除率高于單一血液凈化模式(CVVH),胰島素抵抗組血液中炎性介質(zhì)高于胰島素不抵抗組。3、胰島素抵抗指數(shù)和血液中炎性介質(zhì)(IL-1、IL-6、IL-8、IFN-α)具有正相關(guān)性。
[Abstract]:Objective to study the combined mode of blood purification on clinical efficacy of insulin resistance in patients with MODS, improve insulin resistance of MODS patients to explore the best mode of blood purification for patients with MODS and clarify the possible mechanism of insulin resistance. Methods 60 cases of MODS patients were randomly divided into single mode of blood purification (continuous veno venous hemofiltration) and the combined mode of blood purification group (continuous veno venous hemofiltration hemoperfusion), 30 cases in each group, to observe the basic situation of the two groups of patients: age, gender, within 24 hours after admission APACHE score, SOFA score within 24 hours of hospitalization, collected before treatment, after treatment 7 d clinical indexes: FBG (fasting blood glucose) HbA1c, (HbA1c), FINS (fasting insulin (CRP), C- HOMA-IR (C-reactive protein), insulin resistance index (BG), BGSD BGcv (standard deviation), BG IL-1 (coefficient of variation), interleukin -1, interleukin - (IL-6) 6 (IL-8), interleukin -8 (IFN-), alpha interferon alpha), according to HOMA-IR after treatment (insulin resistance index) of 2.69 groups were divided into treatment and treatment of insulin resistance after insulin resistance group and IL-1 were compared between the two groups (IL -1), IL-6 (interleukin -6 (IL-8). Interleukin -8 (TNF-), alpha interferon alpha) whether there are differences, packet data entry using Epidata 3.02 software, dual input method input to the test data, the two data correct after verification, the data were analyzed with relevant professional using spss20.0 statistical software. Results of the 1, the two independent sample t test: the test group and the control group in age, APACHE score, SOFA score were not statistically significant (P0.05), the four table 2 test: the test group and the control group there was no significant difference in gender (P=0.301): experimental group and control group before treatment FBG (fasting blood glucose), FINS (fasting insulin), HOMA-IR (pancreatic 宀涚礌鎶墊姉鎸囨暟),BGSD(絀鴻吂琛，

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