强化胰岛素治疗对危重产科病人预后的影响

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1、强化胰岛素治疗对产科重症病人的影响徐昉刘琼周发春(重庆医科大学附属第一医院急诊科、中心ICU400016)摘要】目的：研究产科重症病人血清C反应蛋白(Creactiveprotein,CRP)、白细胞介素・6(interleukin-6,IL-6)>肿瘤坏死因子a(TumorNecrosisFactor-a,TNF-a)的变化及其与应激性高血糖的相互关系，探讨强化胰岛素治疗(intensiveinsulintherapy,IIT)对产科重症病人的影响。方法：42例收住小心ICU的产科重症病人随机分为2

2、组：强化治疗组(目标血糖4.44〜6.11mmol/L),常规治疗组(目标血糖9.99〜11.10mmol/L),入选后第1、3、5天测定血清CRP、IL・6、TNF-a.的动态变化。结果：强化治疗组平均每日胰岛素用量更高(PV0.05)o42例治疗前血清CRP、IL・6、TNF-a较正常水平均明显升高，其屮血清CRP与血糖水平呈正相关。IIT后，强化治疗组血清CRP在第5天显著下降(PV0.05),血清IL・6在第5天显著下降(PV0.05)。TNF-a在第1天开始下降(P<0.05),在第5天显著

3、下降(PV0.05)。结论：IT通过将血糖控制在正常水平明显调节损伤后炎症反应，有利于改善出血等应激造成的免疫抑制，将冇益于降低产科重症病人脏器功能损害等并发症的发生，降低死亡率，最终获得改善预后的效果。关键词：强化胰岛素治疗；产科；危重症EffectsofintensiveinsulintherapyonthepatientsofobstetricsduringcriticalillnessXufangetal(DepartmentofEmergencyandCentralIntensiveCare

4、UnittheFirstAffiliatedHospitahChongqingMedicalUniversity,Chongqing400014,China)[Abstract]Objective:ToinvestigatethecoiTelationofstresshyperglycemiawithserumlevelsofCreactiveprotein(CRP),interleukin-6(IL-6)andTNF-a(TumorNecrosisFactor-a)thatincriticalpat

5、ientsofobstetrics；andtoexploretheeffectofintensiveinsulintherapyonthepatientsofobstetricsduringcriticalillness.Methods:Forty-twocriticallyilledpatientswererandomlydividedintotheintensiveinsulintherapygroup(maintenancebloodglucoseatalevelbetween4.4and6.1

6、1mmol/L)andnormaltreatmentgroup(maintenancebloodglucoseatalevelbetween9.99andl11.10mmol/L).LevelsofCreactiveprotein,interleukin-6andtumornecrosisfactor-awereanalyzedbeforeandafterthetreatment.Datawereexpressedasmean土standardandanalyzedbyusingAnalysisofV

7、arianceandcorrelationandlinearregression・APvaluelessthan0.05wasregardedasstatisticallysignificanceinallthetestsconductedinthisstudy.Results：Comparedwiththenormaltreatmentgroup.theintensiveinsulintherapygroupneededmoreinsulintoachievetargetglycemia.There

8、wasasignificantincreaseinserumlevelsofCreactiveprotein,interleukin・6andtumornecrosisfactor-ainall42patientsofobstetricsduringcriticalillness.Creactiveproteinwaspositivelycorrelatedwiththelevelofbloodglucose・Comparedwiththenormalt