摘要
目的探讨强化胰岛素治疗下不同目标血糖管理对脓毒症患者凝血机制的影响。方法研究设计为随机的、前瞻性的、双盲的、临床干预的对照研究。将2015～10～2016—09新疆石河子大学医学院第一附属医院重症医学科（ICU）90例脓毒症患者按随机数字表法分为三组，每组各30例。A组：控制血糖4．4～6．1mmol／L，B组：控制血糖6．1～8．3mmol／L，C组：控制血糖8．3—10．0mmol／L。所有患者在治疗前（110）及治疗后1d、3d、7d（T1、T3、T7）不同时间点分别监测凝血功能指标及相关预后指标，同时记录各组患者性别、年龄、APACHEⅡ评分、SOFA评分、白细胞计数（WBC）、治疗前血糖水平和低血糖发生率。结果三组患者治疗前后凝血指标比较、治疗前（TO）三组患者凝血指标比较差异均无统计学意义（P〉0．05），治疗后A组凝血指标与B、C组比较差异有统计学意义（P〈0．05），B组与C组比较差异有统计学意义（P〈0．05）。同一组不同监测时间点比较，治疗后3d、7d，A组APTT、（S）、PT（S）、FIB（s）、PLT（×10^9／L）较与治疗前改善（P〈0．05）；治疗后7d，B组APTT、PT、FIB、PLT较治疗前改善（P〈0．05）；C组无明显改变（P〉0．05）。A组D-二聚体治疗后7d与治疗前比较差异有统计学意义（P〈0．05）；B组和C组D-二聚体治疗前与后比较差异无统计学意义（P〉0．05）。结论将脓毒症患者血糖控制于4．4～6．1mmol／L，可显著改善其凝血功能，提高28d生存率，改善预后。
Objective To investigate the effect of different blood glucose management under intensive insulin therapy on blood coagulation in patients with sepsis. Methods A randomized, prospective, doubleblind, clinical intervention study was designed. In the First Affiliated Hospital of Shihezi University from October 2015 to September 2016, 90 eases of sepsis patients were randomly divided into 3 groups according to the random number table method. The 30 cases were randomly divided into groups. Group A ： control blood sugar 4.4 - 6.1 mmol/L, group B ： control blood sugar 6.1 - 8.3 mmol/L, group C ： control blood sugar 8.3 - 10.0 mmol/L. All patients after treatment in 1, 3, 7 days at different time points were monitored indexes of coagulation function, simultaneous recording of groups with gender, age, APACHE Ⅱ score, white blood cell count （WBC） , treatment level of blood glucose, hypoglycemia incidence and the ICU hospitalization days, 28 days mortality. Results Three groups of patients before （T0） and after treatment of coagulation indicators, compared with the three groups before treatment, the difference was not statistically significant （ P 〉 0. 05 ）. There was significant difference between the group A and the group B, C, the difference was statistically significant （P 〈0.05）. There was significant difference between group B and group C （P 〈 0.05 ）. Comparison of different monitoring time points was made in the same group. Three days and seven days after treatment in group A, APTT （s）, PT （s）, FIB（s）, PLT（ × 10^9） were improved compared with those before treatment, and the difference was statistically significant （P 〈 0.05）. Seven days after treatment, APTT, PT, FIB, PLT in group B were improved compared with those before treatment, and the difference was statistically significant （P 〈 0.05）. There was no significant difference in group C （ P 〉 0.05 ）. Seven days after treatment, D- dimer level in group A was significantly decreased compared with that before treatment （P 〈 0.05 ） , but the D - dimer levels in group B and group C were not significantly changed by the treatment （ P 〉 0.05 ）. Conclusion In patients with sepsis, blood sugar control within 4.4 - 6. 1 mmol/L, can significantly improve the coagulation function, the survival rate of 28 d and the prognosis.
出处
《中国急救医学》
CAS
CSCD
北大核心
2017年第5期401-405,共5页
Chinese Journal of Critical Care Medicine
关键词
脓毒症
血糖
凝血功能
全身炎症反应综合征(SIRS)
Septic disease
Blood sugar
Coagulation function
Systemic inflammatory Tresponse syndrome （SIRS）
