切换至 "中华医学电子期刊资源库"

中华神经创伤外科电子杂志 ›› 2019, Vol. 05 ›› Issue (04) : 210 -213. doi: 10.3877/cma.j.issn.2095-9141.2019.04.005

所属专题: 文献

临床研究

胰岛素优化疗法对重症颅脑外伤患者应激性高血糖及炎症相关因子的影响
梅喜平1, 郑鲲1,()   
  1. 1. 435000 湖北黄石,鄂东医疗集团黄石市中心医院(湖北理工学院附属医院)重症医学科
  • 收稿日期:2019-04-25 出版日期:2019-08-15
  • 通信作者: 郑鲲
  • 基金资助:
    湖北省自然科学基金(2012FKB07501)

Effect of insulin-optimized therapy on stress hyperglycemia and inflammation related factors in patients with severe craniocerebral trauma

Xiping Mei1, Kun Zheng1,()   

  1. 1. Department of Critical Care Medicine, Huangshi Central Hospital, Edong Healthcare Group (Affiliated Hospital of Hubei Polytechnic University), Huangshi 435000, China
  • Received:2019-04-25 Published:2019-08-15
  • Corresponding author: Kun Zheng
  • About author:
    Corresponding author: Zheng Kun, Email:
引用本文:

梅喜平, 郑鲲. 胰岛素优化疗法对重症颅脑外伤患者应激性高血糖及炎症相关因子的影响[J]. 中华神经创伤外科电子杂志, 2019, 05(04): 210-213.

Xiping Mei, Kun Zheng. Effect of insulin-optimized therapy on stress hyperglycemia and inflammation related factors in patients with severe craniocerebral trauma[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2019, 05(04): 210-213.

目的

观察胰岛素优化疗法对重症颅脑外伤患者应激性高血糖的治疗效果及其对炎症相关因子的影响作用。

方法

选取自2017年6月至2018年12月于鄂东医疗集团黄石市中心医院(湖北理工学院附属医院)重症医学科就诊的重症颅脑外伤患者274例,并将其随机分为观察组和对照组,每组137例。观察组采用胰岛素优化疗法,对照组采用常规胰岛素治疗法,观察2种不同治疗方案对重症颅脑外伤患者应激性高血糖的控制情况。

结果

观察组治疗后肿瘤坏死因子-α、C反应蛋白、肿瘤坏死因子受体Ⅰ、肿瘤坏死因子受体Ⅱ水平明显低于对照组,差异有统计学意义(P<0.05)。2组患者低血糖和手术伤口感染的发生率比较,差异无统计学意义(P>0.05),观察组呼吸系统和泌尿系统感染的发生率明显低于对照组,差异有统计学意义(P<0.05),观察组治疗后GCS评分明显低于对照组,差异有统计学意义(P<0.05)。

结论

胰岛素优化疗法可以减少重症颅脑外伤患者术后感染的发生率,减轻患者的炎症反应,改善患者预后,可以在临床中推广使用。

Objective

To observe the therapeutic effect of insulin-optimized therapy on stress hyperglycemia in severe craniocerebral trauma and its influence on inflammation-related factors.

Methods

A total of 274 patients with severe craniocerebral trauma who were enrolled from June 2017 to December 2018 in Department of Critical Care Medicine, Huangshi Central Hospital, Edong Healthcare Group (Affiliated Hospital of Hubei Polytechnic University), they were randomly divided into the observation group and the control group with 137 patients in each group. The observation group was treated with insulin-optimized therapy, while the control group was treated with conventional insulin therapy. The control of stress hyperglycemia in patients with severe craniocerebral trauma was observed by two different treatment schemes.

Results

The tumor necrosis factor-α, C reactive protein, tumor necrosis factor receptor Ⅰ, tumor necrosis factor receptor Ⅱ levels in the observation group after treatment were significantly lower than those in the control group, the difference was statistically significant (P<0.05). There was no significant difference in incidence of hypoglycemia and surgical wound infection between the observation group and the control group (P>0.05), the incidence of respiratory and urinary system infection in the observation group was significantly lower than that in the control group, the difference was statistically significant (P<0.05). The GCS score in the observation group was significantly lower than that in the control group (P<0.05).

Conclusion

Insulin-optimized therapy can reduce the incidence of postoperative infection in patients with severe craniocerebral trauma, reduce the patient’s inflammatory response and improve the prognosis of patients. It can be widely used in clinical practice.

表1 2组患者治疗前后肿瘤坏死因子-α、C反应蛋白水平比较(±s
表2 2组患者治疗前后肿瘤坏死因子受体Ⅰ、肿瘤坏死因子受体Ⅱ水平比较(±s,μg/L)
表3 2组患者术后低血糖与术后感染发生率比较[例(%)]
表4 2组患者治疗前后GCS评分比较(±s
[1]
Hirsch IB, Buse JB, Leahy J, et al. Options for prandial glucose management in type 2 diabetes patients using basal insulin: addition of a short-acting GLP-1 analogue versus progression to basal-bolus therapy[J]. Diabetes Obes Metab, 2014, 16(3): 206-214.
[2]
Abd El-Wahab EW, Mikheal A, Sidkey F, et al. Insulin resistance as a predictor of early virologic response to HCV therapy among chronic HCV Egyptian patients[J]. J Med Virol, 2015, 87(3): 428-440.
[3]
Shubrook JH Jr. Insulin therapy for challenging patient cases[J]. J Am Osteopath Assoc, 2013, 113(4 Suppl 2): S17-S28.
[4]
Tuo J, Sun H, Shen D, et al. Optimization of insulin pump therapy based on high order run-to-run control scheme[J]. Comput Methods Programs Biomed, 2015, 120(3): 123-134.
[5]
Warren M, Goodhue W. Cerebral tissue pulmonary embolism after severe head trauma in an infant[J]. Am J Forensic Med Pathol, 2013, 34(1): 9-10.
[6]
Xu G, Hu B, Chen G, et al. Analysis of blood trace elements and biochemical indexes levels in severe craniocerebral trauma adults with Glasgow Coma Scale and injury severity score[J]. Biol Trace Elem Res, 2015, 164(2): 192-197.
[7]
Thomas AG, Hegde SV, Dineen RA, et al. Patterns of accidental craniocerebral injury occurring in early childhood[J]. Arch Dis Child, 2013, 98(10): 787-792.
[8]
Richards JE, Kauffmann RM, Obremskey WT, et al. Stress-induced hyperglycemia as a risk factor for surgical-site infection in nondiabetic orthopedic trauma patients admitted to the intensive care unit[J]. J Orthop Trauma, 2013, 27(1): 16-21.
[9]
Chen Y, Yang X, Meng K, et al. Stress-induced hyperglycemia after hip fracture and the increased risk of acute myocardial infarction in nondiabetic patients[J]. Diabetes Care, 2013, 36(10): 3328-3332.
[10]
Bosarge PL, Shoultz TH, Griffin RL, et al. Stress-induced hyperglycemia is associated with higher mortality in severe traumatic brain injury[J]. J Trauma Acute Care Surg, 2015, 79(2): 289-294.
[11]
Wang JY, Zhu C, Qian T, et al. Extracts of black bean peel and pomegranate peel ameliorate oxidative stress-induced hyperglycemia in mice[J]. Exp Ther Med, 2015, 9(1): 43-48.
[12]
Li L, Ye XP, Lu AZ, et al. Hyperglycemia magnifies bupivacaine-induced cell apoptosis triggered by mitochondria dysfunction and endoplasmic reticulum stress[J]. J Neurosci Res, 2013, 91(6): 786-798.
[13]
Taha H, Arya A, Paydar M, et al. Upregulation of insulin secretion and downregulation of pro-inflammatory cytokines, oxidative stress and hyperglycemia in STZ-nicotinamide-induced type 2 diabetic rats by Pseuduvaria monticola bark extract[J]. Food Chem Toxicol, 2014, 66: 295-306.
[14]
Okamura K, Tsubokawa T, Johshita H, et al. Edaravone, a free radical scavenger, attenuates cerebral infarction and hemorrhagic infarction in rats with hyperglycemia[J]. Neurol Res, 2014, 36(1): 65-69.
[15]
Camara ML, Corrigan F, Jaehne EJ, et al. Tumor necrosis factor alpha and its receptors in behaviour and neurobiology of adult mice, in the absence of an immune challenge[J]. Behav Brain Res, 2015, 290: 51-60.
[16]
Arjuman A, Chandra NC. Differential pro-inflammatory responses of TNF-α receptors (TNFR1 and TNFR2) on LOX-1 signalling[J]. Mol Biol Rep, 2015, 42(6): 1039-1047.
[17]
Teixeira AL, de Sousa RT, Zanetti MV, et al. Increased plasma levels of soluble TNF receptors 1 and 2 in bipolar depression and impact of lithium treatment[J]. Hum Psychopharmacol, 2015, 30(1): 52-56.
[1] 王龙彪, 刘洪, 董天雄. 中心体扩增细胞占比和C反应蛋白-白蛋白比值对胃癌根治术治疗预后的预测价值[J]. 中华普通外科学文献(电子版), 2023, 17(05): 352-356.
[2] 冯树森, 张东成, 郭奇, 张皓露, 陈阔. 两种手术方法对急性阑尾炎患者的临床疗效及对炎性因子的影响比较[J]. 中华普外科手术学杂志(电子版), 2023, 17(04): 447-450.
[3] 刘立, 陈诚, 李新科, 刘凯, 屠昌明. 血清IL-6、hs-CRP、MMP-9联合检测在腹股沟疝无张力修补术预后评价中的价值分析[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(04): 405-409.
[4] 安钱, 徐彬, 陈志祥, 徐晶晶, 黄丹丹. PCT、CRP及SAA对呼吸机相关性肺炎病情严重程度和预后分析[J]. 中华肺部疾病杂志(电子版), 2023, 16(04): 544-546.
[5] 芦丹, 杨硕, 刘旭. VEGF、HMGB1、hs-CRP/Alb在AECOPD伴呼吸衰竭中的变化及预后分析[J]. 中华肺部疾病杂志(电子版), 2023, 16(04): 532-534.
[6] 李海明, 刘鸿飞, 李俊. 血清脂蛋白酶水平与COPD患者骨骼肌质量减少的关系[J]. 中华肺部疾病杂志(电子版), 2023, 16(04): 500-503.
[7] 崔立慧, 李士荣, 李素娟, 孙娴静, 张馨怡. 糖尿病患者肺部感染超敏C反应蛋白和降钙素原检测的临床意义[J]. 中华肺部疾病杂志(电子版), 2023, 16(01): 95-97.
[8] 肖田恬, 丁桃容, 刘婷婷. 异丙托溴铵联合糖皮质激素治疗COPD的临床分析[J]. 中华肺部疾病杂志(电子版), 2022, 15(06): 885-887.
[9] 汪玲玲, 申潇竹, 贾嵘, 包勤文. CRP/AIb、NLR及CD64%对老年肺部感染预后的意义[J]. 中华肺部疾病杂志(电子版), 2022, 15(06): 859-862.
[10] 倪文凯, 齐翀, 许小丹, 周燮程, 殷庆章, 蔡元坤. 结直肠癌患者术后发生延迟性肠麻痹的影响因素分析[J]. 中华结直肠疾病电子杂志, 2023, 12(06): 484-489.
[11] 卓少宏, 林秀玲, 周翠梅, 熊卫莲, 马兴灶. CD64指数、SAA/CRP、PCT联合检测在小儿消化道感染性疾病鉴别诊断中的应用[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 505-509.
[12] 孙旻. 血液淀粉酶、C反应蛋白、降钙素原及乳酸脱氢酶在急性胰腺炎患者病情评价及预后预测中的价值[J]. 中华消化病与影像杂志(电子版), 2023, 13(05): 331-336.
[13] 王庆, 夏婷婷. 未成熟粒细胞计数、C反应蛋白、中性粒细胞/淋巴细胞、降钙素原结合MCTSI评分在急性胆源性胰腺炎中的诊断价值[J]. 中华消化病与影像杂志(电子版), 2023, 13(04): 224-228.
[14] 陈丽娜, 虞意华, 徐靓, 龚仕金, 汪月奔. 中性粒细胞与淋巴细胞比值和C反应蛋白与淋巴细胞比值对老年脓毒症患者28天病死率的预测价值[J]. 中华老年病研究电子杂志, 2023, 10(02): 28-32.
[15] 韩远远, 于紫涵, 杨玲, 程弘禹, 宋春杰. C反应蛋白与白蛋白比值和中性粒细胞与淋巴细胞比值对老年帕金森病的诊断价值[J]. 中华老年病研究电子杂志, 2023, 10(01): 14-19.
阅读次数
全文


摘要