摘要
目的观察早期强化胰岛素治疗前后儿童脓毒症患者血清D-乳酸与降钙素原(PCT)水平的变化及疗效评估,探讨其保护儿童脓毒症患者肠黏膜屏障的功效。方法选取2011年5月～2017年9月我院儿科住院治疗儿童脓毒症患者64例,随机分为观察组和对照组。两组患儿予以抗生素抗感染、液体支持复苏、能量支持和原发病治疗等治疗。观察组予以强化胰岛素治疗,将胰岛素用微泵持续泵入,维持血糖4.4～6.1 mmol/L;对照组予以常规胰岛素治疗,维持血糖10.0～11.1 mmol/L。分析两组患儿治疗前和治疗7 d后血清D-乳酸和PCT指标的变化,并比较其临床疗效。结果治疗7 d后,两组患儿病例血清D-乳酸与PCT水平均较治疗前均有不同程度下降(P<0.01或P<0.05),且观察组较对照组下降幅度更显著(P<0.05);同时观察组患儿临床总有效率(93.75%)高于对照组(75.00%)(χ~2=4.27,P<0.05)。结论早期强化胰岛素治疗儿童脓毒症显著优于常规胰岛素治疗,能降低血清D-乳酸和PCT指标,保持肠黏膜结构与功能完整,使肠黏膜的通透性降低对肠黏膜屏障功能的起保护作用。
Objective To observe the changes of serum D-lactate and procalcitonin（PCT） levels in the children with sepsis before and after early intensive insulin therapy and evaluate the efficacy, so as to explore its efficacy in protect- ing the intestinal mucosal barrier in the children with sepsis. Methods From May 2011 to September 2017, 64 children patients with sepsis who were hospitalized for treatment in the Department of Pediatrics in our hospital were selected, and randomly divided into observation group and control group. The two groups of children patients were given antibi- otics for anti-infection, liquid support resuscitation, energy support and treatment of primary underlying disease. The observation group was given intensive insulin therapy, and a micropump was used to pump insulin continuously. The blood glucose was maintained between 4.4-6.1 mmol/L; the control group was given regular insulin treatment. The blood glucose was maintained between 10.0-11.1 mmol/L. The changes of serum D-lactate and PCT indexes before treatment and 7 d after treatment in the two groups of children patients were observed and recorded, and their clinical efficacy was compared. Results After treatment for 7 days, the serum D-lactate and PCT levels in both groups of chil- dren patients were decreased to different degrees compared before treatment（P〈0.01 or P〈0.05）, and the decrease was more significant in the observation group than in the control group（P〈0.05）; at the same time, the total clinical efficacy （93.75%） was higher in the observation group than in the control group（75.00%）（x2=4.27, P〈0.05）. Conclusion Early intensive insulin therapy in the treatment of children with sepsis is significantly better than conventional insulin thera- py, which can reduce serum D-lactate and PCT indicators, maintain the integrity of intestinal mucosal structure and function, and reduce the permeability of the intestinal mucosa, showing the effects of protecting intestinal mucosal bar- rier.
作者
朱莲
潜丽俊
ZHU Lion;QIAN Lijun(Department of Pediatrics,Lishui Central Hospital in Zhejiang Province,Lishui 323000,China)
出处
《中国现代医生》
2018年第23期46-48,52,共4页
China Modern Doctor
基金
浙江省医药卫生科技计划项目(2016KYB337)
