贵州医科大学学报

2018, v.43;No.218(11) 1318-1323

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小剂量胰岛素对严重烧伤延迟复苏患者心肾损害的保护作用
Effect of Insulin on Heart and Kidney Damage in Burned Patients with Delayed Fluid Resuscitation

杨亚南;李伟人;孔豫苏;陈祥军;杨抒;喻翔;
YANG Yanan;LI Weiren;KONG Yusu;CHEN Xiangjun;YANG Shu;YU Xiang;Department of Burns and Plastic Surgery,the Affiliated Hospital of Guizhou Medical University;

摘要(Abstract):

目的:探讨胰岛素干预对严重烧伤延迟复苏患者心、肾损害的保护作用。方法:将50例严重烧伤延迟复苏患者,于烧伤6 h后连续3 d每日皮下注射甘精胰岛素,根据注射剂量分为对照组、0. 05 U/(kg·d)组、0. 10 U/(kg·d)组、0. 15 U/(kg·d)组及0. 20 U/(kg·d)组,并于注射后6、12、24、48、72 h采集静脉血,分离血清,采用分光光度法测定血糖、肌酸激酶(CK)、乳酸脱氢酶(LDH)、尿素氮(BUN)、肌酐(Cr)),免疫抑制法测定肌酸激酶同工酶(CK-MB)。结果:对照组血糖、CK、CK-MB、LDH、BUN及Cr水平均显著高于甘精胰岛素注射组,且烧伤3 d后仍处于高值(P <0. 05); 0. 05 U/(kg·d)组血糖、CK、CK-MB、LDH、BUN、Cr水平均显著低于对照组,高于0. 10 U/(kg·d)组、0. 15 U/(kg·d)组及0. 20 U/(kg·d)组(P <0. 05); 0. 10 U/(kg·d)组、0. 15 U/(kg·d)组及0. 20 U/(kg·d)组血糖、CK、CK-MB、LDH、BUN、Cr逐渐降低,部分结果正常; 0. 20 U/(kg·d)组结果烧伤72 h后各指标基本正常,偶有低血糖反应。结论:小剂量甘精胰岛素干预对严重烧伤延迟复苏患者心、肾损害有保护作用。
Objective: To investigate the protective effect of insulin against heart and kidney damage in burned patients with delayed fluid resuscitation. Methods: 50 patients with severe burn delayed resuscitation(without diabetes mellitus) were randomly divided into 5 groups according to the injection doses of insulin glargine(0 U/kg·d,0. 05 U/kg·d,0. 1 U/kg·d,0. 15 U/kg·d and 0. 2 U/kg·d respectively) and were injected subcutaneously daily in 6 h after burn(three days in succession).The vein blood was collected in 6 h,12 h,24 h,48 h and 72 h after injection of insulin glargine. A spectrophotometric method for the determination of glucose,creatine kinase(CK),lactate dehydrogenase(LDH),blood urea nitrogen(BUN),creatinine(Cr),creatine kinase MB(CK-MB) were determined by immunosuppression. Results: The blood glucose,CK,CK-MB,LDH,BUN and Cr of Group 1(the controls with 0 U/kg·d) were significantly higher than those of Groups 2 ~ 5,and three days after burn were still at a high level(P < 0. 05); The blood glucose,CK,CK-MB,LDH,BUN and Cr of Group 2 were significantly lower than those of the controls,higher than those of Group 3 ~ 5 and 3 days after the burn the measurement value was low(P < 0. 05); The blood glucose,CK,CKMB,LDH,BUN and Cr were gradually lower in Groups 3,4 and 5,with partly normal results. The results of Group 5 were basically normal 72 h after the burn,and there was hypoglycemia(P < 0. 05).Conclusion: Low dose injection of insulin glargine has protective function against heart and kidney damage in patients with severe burn delayed resuscitation.

关键词(KeyWords): 胰岛素;烧伤;延迟复苏;心脏损伤;肾脏损伤;血糖;肌酸激酶;乳酸脱氢酶;肌酸激酶同工酶;尿素氮
insulin;burn;delayed fluid resuscitation;heart damage;kidney damage;blood glucose;creatine kinase;lactate dehydrogenase;creatine kinase isoenzyme;urea nitrogen

Abstract:

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基金项目(Foundation): 贵州省科技厅联合基金[黔科合LH字(2015)7441号]

作者(Author): 杨亚南;李伟人;孔豫苏;陈祥军;杨抒;喻翔;
YANG Yanan;LI Weiren;KONG Yusu;CHEN Xiangjun;YANG Shu;YU Xiang;Department of Burns and Plastic Surgery,the Affiliated Hospital of Guizhou Medical University;

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DOI: 10.19367/j.cnki.1000-2707.2018.11.016

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