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1、多发伤患者胰岛素抵抗的临床研究山东省兖矿集团第三医院山东济宁272072【摘要】目的观察多发伤患者空腹血糖(FBG)、胰岛素(FINS)、C肽(CP)、肿瘤坏死因子(TNF・a)、白介素(IL-8)的变化及意义。方法100例创伤患者，根据ISS评分，把其分为轻伤(ISS评分＜16分)，重伤(16分≤ISS评分＜25分)，严重伤(ISS评分&匪;25分)。并于伤后1,3,5,7,9d晨起空腹抽取肘静脉血，检测FBG、FINS、CP、TNF・a、IL・8的水平,测算胰岛素敏感指数(ISI),进行统计学分析，比较各组间差异及其对预后
2、的影响。结果FBG、FINS、CP、TNF-a、IL・8在伤后早期即升高，3〜6d达高峰后开始下降，三组在伤后的升高程度和持续时间有显著差异,而ISI是下降的。FBG、FINS、CP、TNF・a、IL・8若下降后再升高则预示创伤感染及其它并发症的发牛。结论创伤引起血糖升高并存在胰岛素抵抗(InsulinresistanceIR),与创伤的严重程度呈正相关。血清FBG、FINS、CP、TNF・a、IL・8的动态变化有助于监测多发伤伤情、判断预后和指导临床治疗。【关键词】多发伤；肿瘤坏死因子-α；胰岛素抵抗；预后Clinic
3、alobservationofinsulinresistsneewithmultipletraumapatientsJIANGQing-he,LIUGuang-xiang,LIJia-xing.No.3HospitalofYanZhouMiningGroup,Jining,272072,China【Abstract】ObjectiveToobservethevariationandsign讦icanceoffastingbloodsugar(FBG),insulin,epeptide(CP),tumornecrosisfactor-
4、α(TNF-α)interleukin-8(IL-8)inpatientswithmultipletrauma・MethodsAccordingtoinjuryseverityscore(ISS),100patientswithmutipletraumaweredividedintothreegroups：slighttraumamultiplegroup(ISS≤16),severemultipletraumagroup(16<ISS<25),andextremelyseveremulti
5、pletraumagroup(ISS≥25).ThebloodwasdrawnfromcubitalveinfordeterminationofFBG,FINS,CP,TNF-αandIL-8weremeasuredatday1,3,5,7and9afterinjury,insulinsenstiveindex(ISI)wascalculated,comparedwiththedatasofthreegroupsandtheinflueneetoprognosis.ResultsThelevelsofFBG,FIN
6、S,CP,TNF-αandIL-8inserumofmultipletraumapatientsincreasedsigrdficantlyatearlystageaftertrauma,andreachedthepeakvalue3〜6dlaterandthendecreased」fthelevelofserumproinflammatorycytokinesincreaseagainafterdecrease,itpredictthattraumaticinfectionorothercomplicationswil
7、loccure.ConclusionFastingbloodsugar(FBG)oftraumpatientsrosemarkedlyshowinsulinresistance(IR),TherearepositivecorrelationbetweentheincreaseofISSandtheincreaseofserumlevelsofFBG,FINS,CP,TNF-αandIL-8.TheserumlevelofFBG,FINS,CP,TNF-αandIL-8arehepfultopredictthe
8、traumaticinfectionandprognosisofmultipletrauma.【Keywords］Multipletrauma；tumornecrosisfactor・α；insulinresistanee
