【摘要】：目的:探討胰島素強(qiáng)化治療對(duì)多發(fā)傷伴應(yīng)激性糖尿病患者相關(guān)指標(biāo)的影響。方法:82例多發(fā)傷伴應(yīng)激性糖尿病患者隨機(jī)分為觀察組和對(duì)照組,每組41例。兩組患者均結(jié)合創(chuàng)傷情況進(jìn)行針對(duì)性處理和常規(guī)治療。在此基礎(chǔ)上,觀察組患者給予生物合成人胰島素注射液,微量泵滴注,滴速為1~2 IU/h,并根據(jù)實(shí)時(shí)血糖值調(diào)節(jié)胰島素微量泵的滴速;對(duì)照組患者給予鹽酸二甲雙胍片起始劑量0.5 g,每日2次,隨餐服用,根據(jù)患者血糖監(jiān)測(cè)結(jié)果適當(dāng)增加劑量至1 g,每日2次。兩組均連續(xù)治療10 d。觀察兩組患者治療前后血清C反應(yīng)蛋白(CRP)、腫瘤壞死因子α(TNF-α)、白細(xì)胞介素1(IL-1)、IL-6、平均血糖值,局部感染、膿毒癥和全身炎癥反應(yīng)綜合征等并發(fā)癥發(fā)生情況及不良反應(yīng)發(fā)生情況。結(jié)果:治療后,兩組患者血清CRP、TNF-α、IL-1、IL-6、平均血糖值水平均顯著低于同組治療前,且5、10 d后觀察組患者血清CRP、IL-1、IL-6水平和1、5、10 d后TNF-α、平均血糖值均顯著低于對(duì)照組同期,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。觀察組患者并發(fā)癥總發(fā)生率顯著低于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。兩組患者治療期間均未見(jiàn)明顯不良反應(yīng)發(fā)生。結(jié)論:在常規(guī)治療的基礎(chǔ)上,胰島素強(qiáng)化治療多發(fā)傷伴應(yīng)激性糖尿病能夠更加有效地降低患者血糖和炎癥因子水平,防止多發(fā)傷后并發(fā)癥的發(fā)生,且不增加不良反應(yīng)的發(fā)生。
[Abstract]:Objective: to investigate the effect of intensive insulin therapy on the related indexes of multiple injury patients with stress diabetes mellitus. Methods 82 patients with multiple injury and stress diabetes were randomly divided into observation group and control group with 41 cases in each group. The patients in both groups were treated with specific treatment and routine treatment combined with trauma. On this basis, the patients in the observation group were treated with biosynthetic human insulin injection and micropump infusion at a drip rate of 1 ~ 2 IU/h, and the droplet velocity of the insulin micropump was adjusted according to the real-time blood glucose value. Patients in the control group were given metformin hydrochloride at the initial dose of 0.5 g, twice a day, with meals. According to the results of blood glucose monitoring, the dosage was increased to 1 g, twice a day. Both groups were treated continuously for 10 days. Serum C-reactive protein (CRP), tumor necrosis factor 偽 (TNF- 偽), interleukin-1 (IL-1), interleukin-6 (IL-6), mean blood glucose, local infection, sepsis and systemic inflammatory response syndrome were observed before and after treatment. Results: after treatment, the serum levels of CRP,TNF- 偽 IL-1hIL-6 and average blood glucose in the two groups were significantly lower than those in the same group before treatment, and the levels of serum CRP,IL-1,IL-6 and TNF- 偽 in the observation group were significantly lower than those in the control group 10 days after treatment (P0.05). The total incidence of complications in the observation group was significantly lower than that in the control group (P0.05). No significant adverse reactions occurred during treatment in both groups. Conclusion: on the basis of routine treatment, intensive insulin therapy for multiple injuries with stress diabetes can more effectively reduce the level of blood glucose and inflammatory factors, prevent the occurrence of complications after multiple injuries, and do not increase the occurrence of adverse reactions.
【作者單位】： 永康市第一人民醫(yī)院重癥醫(yī)學(xué)科;
【分類號(hào)】：R587.1

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