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胰岛素治疗在烧伤休克复苏中的应用初探 被引量:7

Application of systemic insulin in burn resuscitation
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摘要 目的观察应用胰岛素对大面积烧伤患者休克期休克复苏液体需要量、患者尿量及脏器功能的影响,初步探索胰岛素治疗在烧伤休克复苏中的应用价值。方法急诊入院大面积烧伤患者42例,抽签法随机分为胰岛素治疗组和常规治疗组。按照"瑞金公式"计算初始复苏所需胶晶体量,并根据患者全身情况及尿量等情况做相应增减。每日水分补充,常规治疗组给予葡萄糖溶液和维生素C,胰岛素治疗组给予由葡萄糖溶液、常规胰岛素、氯化钾及维生素配置而成的GIKC溶液。记录两组患者第一个24h实际输注胶、晶体量,并根据体重和烧伤面积计算第一个24h单位胶(晶)体量;记录第一个24h尿量及休克期(伤后72h)总尿量,计算单位尿量;同时检测红细胞压积、血小板计数及伤后肝肾功能等相关生化指标。结果胰岛素治疗组第一个24h单位胶体量为(0.72±0.09)ml.kg-1.1%TBSA-1,较常规治疗组(0.86±0.25)ml.kg-1.1%TBSA-1明显减少(P<0.05)。休克期单位尿量,胰岛素治疗组(1.87±0.51)ml.kg-1.h-1较常规治疗组(1.42±0.59)ml.kg-1.h-1明显增加(P<0.05)。胰岛素治疗组伤后第二天起血小板计数高于常规治疗组。伤后第二天起胰岛素治疗组总胆红素(TBIL)、直接胆红素(DBIL)、尿素氮(BUN)和肌酐(Cr)值均低于常规治疗组,并于大部分时相点差异有统计学意义(P<0.05)。结论休克期应用胰岛素可降低大面积烧伤患者复苏所需胶/晶体溶液需要量、增加尿量,同时可减轻组织损伤程度和保护脏器功能。研究结果显示胰岛素在严重烧伤休克复苏中的具有潜在应用价值。 Objective This study explored the effects of systemic administration of insulin on resuscitation fluid requirement, urine output as well as organ function of severe burn patients, and to evaluate the application of insulin in burn resuscitation. Methods Forty-two severe burn patients admitted to our burn unit were randomly assigned to treatment group and control group. The initial resuscitation colloid and crystalloid solution volume were estimated using "Ruijin formula". Adjustment was made based on patients' v, ital signs and urine output. For dairy physiological water supplement, control group received glucose solution plus vitamin C, treatment group received same amount of GIKC solution which contained glucose solution, regular insulin, potassium chloride and vitamin C. The actual infusion volume of colloid and erystalloid solution in the first 24 hours after injury were recorded, and the 1 st 24 hour "Unit colloid and crystalloid solution" was calculated according to patients' body weight and burn area ; and the urine output of 1st 24 hour and shock stage (72 hours after injury) were recorded and the " Unit urine output" was calculated as well. Meanwhile, hematocrit, platelet counting and liver and kidney function related biochemical parameters were measured and recorded. Results There was no significant difference on patients' general characteristics, including age, body weight, burn area, etc. The "Unit colloid volume" of 1 st 24 hour for treatment group was ( 0.72± 0. 09 ) ml ·kg - 1 . 1% TBSA - l which was significantly less than ( 0.86 ± 0.25 ) ml · kg - 1 1% TBSA - 1 with control group ( P 〈 0.5 ). Conversely, "Unit rrine output" of 1 st 24 hour for treatment group was ( 1.87 ± 0. 51 ), which was significantly higher than ( 1.42 ± 0.59 ) ml · kg ^-1 · h ^- 1 in control group ( P 〈 0.5 ). The platelet counting of treatment group was significantly higher than control group. Lower level of total bilirubin, direct bilirubin, blood urea nitro
出处 《中华损伤与修复杂志(电子版)》 CAS 2012年第1期47-50,58,共5页 Chinese Journal of Injury Repair and Wound Healing(Electronic Edition)
基金 国家自然科学基金面上项目(30973115 81170761)
关键词 胰岛素 休克复苏 血管通透性 脏器功能保护 Insulin Resuscitation Vessel permeability Reactive oxygen species
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