强化胰岛素治疗对危重产科病人预后的影响.doc

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：重症病人血清C反应蛋白reactive protein ，CRP）、白细胞介素-6（interleukinIL-6）、肿瘤坏死因子α（Tumor Necrosis Factor-α, TNF-α）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（intensive insulin therapy，IIT）对重症病人的影响。例收住ICU的重症病人分为组：组目标血糖444～611 mmol/L），组目标血糖999～1110 mmol/L），入选后第1、、天测定血清CRP、IL-6TNF-α、的动态变化。结果：强化治疗组平均每胰岛素用量高P＜0.05）。42例血清CRP、IL-6、TNF-α较正常水平均明显升高，其中血清CRP与血糖水平呈正相关血清CRP在第天P＜0.05），血清IL-6在第天P＜0.05）。TNF-α在P＜0.05），在第天P＜0.05）。结论 IT通过将血糖控制在正常水平损伤后炎症反应，有利于改善出血等应激造成的免疫抑制，将有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：；产科；Effects of intensive insulin therapy on the patients of obstetrics during critical illness Xufang et al (Department of Emergency and Central Intensive Care Unit the First Affiliated Hospital，Chongqing Medical University，Chongqing 400014，China) 【Abstract】0bjective To investigate the correlation of stress hyperglycemia with serum levels of C reactive protein(CRP)，interleukin-6(IL-6)and TNF-αTumor Necrosis Factor-α)that in critical patients of obstetrics；and to the effect of intensive insulin therapy on the patients of obstetrics during critical illness. Methods: Forty-two critically illed patients were randomly divided into the intensive insulin therapy group (maintenance blood glucose at a level between 4.4 and 6.1 1 mmol/L) and normal treatment group(maintenance blood glucose at a level between 9.99 and1 11.10 mmol/L)．C reactive protein, interleukin-6 and tumor necrosis factor-α were analyzed before and after the treatment．Data were expressed as ean ±standard and analyzed by using Analysis of Variance and correlation and linear regression．A P value0.05 was regarded as statistically significance in all the tests conducted in this study．ResultsCompared with the normal treatment group，the intensive insulin therapy group needed more insulin to achieve target glycemia．There increase in serum levels of C reactive protein，interleukin-6 and umor necrosis factor-α in all 42 patients of obstetrics during critical illness. C reactive pr