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目的:探讨胰岛素强化治疗(IIT)对严重创伤预后影响及其机制。方法:将41例严重创伤伴应急性高血糖患者随机分为常规治疗(CT)组(n=21)和IIT组(n=20),两组均予以创伤常规治疗,CT组静脉注射常规胰岛素(RI)将血糖控制在10-11.1mmol/L;IIT组将血糖控制在4.4-6.1mmol/L。比较两组治疗前、治疗后24h、48 h、72 h、1周血浆TNF-α、IL-10、外周血多形核中性粒细胞(PMNs)凋亡率,APACHⅡ评分,住院期间病死率。结果:IIT组治疗后24 h、48 h、72 h、1周血浆TNF-α、IL-10水平,1周时APACHⅡ评分、住院期间病死率均明显低于CT组(P均<0.05);ⅡT组治疗后48 h、72 h及1周时外周PMNs凋亡率显著高于CT组(P均<0.01)。结论:IIT可改善严重创伤病人的预后,其作用机制除了降低应激性高血糖的直接毒性作用外,还可能通过促进严重创伤后PMNs凋亡,降低血浆促炎细胞因子,调节过度的炎症反应。
Objective: To investigate the effect and mechanism of intensive insulin therapy (IIT) on the prognosis of severe trauma. Methods: Forty-one patients with severe trauma and acute hyperglycemia were randomly divided into conventional therapy (n = 21) and IIT group (n = 20). Both groups were treated with conventional trauma. CT group received intravenous conventional insulin (RI) to control blood sugar at 10-11.1mmol / L; IIT group to control blood sugar at 4.4-6.1mmol / L. The levels of TNF-α, IL-10, polymorphonuclear neutrophil (PMNs) apoptosis rate, APACH Ⅱ score, hospitalization mortality before treatment, 24 h, 48 h, 72 h, . Results: The plasma levels of TNF-α and IL-10 at 24 h, 48 h, 72 h and 1 week after treatment in IIT group were significantly lower than those in CT group (P <0.05). The apoptotic rates of peripheral PMNs in group ⅡT at 48 h, 72 h and 1 week were significantly higher than those in CT group (all P <0.01). Conclusion: IIT can improve the prognosis of patients with severe trauma. Its mechanism not only reduces the direct toxicity of stress-induced hyperglycemia, but also promotes the apoptosis of PMNs after severe trauma, decreases plasma pro-inflammatory cytokines and regulates excessive inflammatory response .