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目的探讨强化胰岛素治疗对脓毒症患者血清D-乳酸及前降钙素水平的影响及疗效观察。方法选取脓毒症患者72例,随机分为强化组和对照组,每组36例。两组患者均予以抗生素抗感染、能量支持及治疗基础疾病等常规治疗,必要时行机械通气或血管活性药物。强化组患者将50 U胰岛素加入50 mL生理盐水中微量泵控制血糖5.0~7.0 mmol/L;对照组患者血糖控制在10.0~11.9 mmol/L,当血糖超过时才加用胰岛素治疗。观察两组患者治疗前和治疗7 d后血清D-乳酸及前降钙素水平的变化,并比较其临床疗效。结果治疗7 d后,两组患者血清D-乳酸及前降钙素水平均较前明显下降(P<0.01或P<0.05),且强化组下降值明显大于对照组(P<0.05);强化组患者的临床总有效率明显高于对照组(94.44%vs.77.78%)(χ2=4.18,P<0.05)。结论强化胰岛素治疗脓毒症患者具有较好的临床疗效,能明显降低血清D-乳酸及前降钙素水平的影响,改善肠黏膜屏障功能。
Objective To investigate the effect of intensive insulin therapy on the serum levels of D-lactate and procalcitonin in patients with sepsis and its therapeutic effect. Methods Seventy-two patients with sepsis were randomly divided into intensive group and control group, with 36 cases in each group. Both groups were given anti-infective antibiotics, energy support and treatment of underlying diseases such as conventional treatment, if necessary, mechanical ventilation or vasoactive drugs. In the intensive group, the 50 U insulin was added to 50 mL of saline to control the blood glucose 5.0-7.0 mmol / L. The control group was treated with 10.0-11.9 mmol / L of blood glucose. When the blood glucose exceeded, insulin was added. The changes of serum D-lactate and procalcitonin before treatment and after 7 days of treatment were observed in both groups, and their clinical effects were compared. Results After 7 days of treatment, the levels of serum D-lactate and procalcitonin were significantly decreased in both groups (P <0.01 or P <0.05), and the values in the intensive group were significantly greater than those in the control group (P <0.05) The total effective rate of the patients in the group was significantly higher than that in the control group (94.44% vs 77.78%) (χ2 = 4.18, P <0.05). Conclusion Intensive insulin therapy in patients with sepsis has better clinical efficacy, can significantly reduce the serum D-lactate and procalcitonin levels, improve intestinal mucosal barrier function.