早期強化胰島素治療對兒童膿毒癥患者腸黏膜屏障功能的影響

朱蓮　潛麗俊

[摘要] 目的 觀察早期強化胰島素治療前后兒童膿毒癥患者血清D-乳酸與降鈣素原（PCT）水平的變化及療效評估，探討其保護兒童膿毒癥患者腸黏膜屏障的功效。 方法 選取2011年5月～2017年9月我院兒科住院治療兒童膿毒癥患者64例，隨機分為觀察組和對照組。兩組患兒予以抗生素抗感染、液體支持復蘇、能量支持和原發病治療等治療。觀察組予以強化胰島素治療，將胰島素用微泵持續泵入，維持血糖4.4～6.1 mmol/L；對照組予以常規胰島素治療，維持血糖10.0～11.1 mmol/L。分析兩組患兒治療前和治療7 d后血清D-乳酸和PCT指標的變化，并比較其臨床療效。 結果 治療7 d后，兩組患兒病例血清D-乳酸與PCT水平均較治療前均有不同程度下降（P<0.01或P<0.05），且觀察組較對照組下降幅度更顯著（P<0.05）；同時觀察組患兒臨床總有效率（93.75%）高于對照組（75.00%）（χ2=4.27，P<0.05）。 結論 早期強化胰島素治療兒童膿毒癥顯著優于常規胰島素治療，能降低血清D-乳酸和PCT指標，保持腸黏膜結構與功能完整，使腸黏膜的通透性降低對腸黏膜屏障功能的起保護作用。

[關鍵詞] 膿毒癥；兒童；胰島素；早期強化治療；D-乳酸；降鈣素原（PCT）

[中圖分類號] R725.9 [文獻標識碼] B [文章編號] 1673-9701（2018）23-0046-03

Effect of early intensive insulin therapy on intestinal mucosal barrier function in the children with sepsis

ZHU Lian QIAN Lijun

Department of Pediatrics，Lishui Central Hospital in Zhejiang Province，Lishui 323000，China

[Abstract] 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 protecting 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 antibiotics 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 children 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%）（χ2=4.27， P<0.05）. Conclusion Early intensive insulin therapy in the treatment of children with sepsis is significantly better than conventional insulin therapy， 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 barrier.

[Key words] Sepsis；Children；Insulin；Early intensive therapy；D-lactate；Procalcitonin（PCT）

膿毒癥是一種臨床常見的急重癥，其病情較重、進展快，可發展為膿毒癥休克和多臟器功能障礙，臨床上死亡率居高不下[1，2]。膿毒癥的致病機制目前尚不清楚，近年來腸黏膜屏障功能障礙在其發病中的作用越來越受到臨床重視[3，4]。腸黏膜屏障功能臨床上多采用間接的血清學指標測定，常用的有D-乳酸及降鈣素原（PCT）[5，6]。兒童膿毒癥早期予以胰島素強化治療的療效肯定，能控制患兒應激性的高血糖，降低其死亡率，但其對腸黏膜通透性的影響如何臨床研究較少[7，8]。本研究觀察了兒童膿毒癥患者予以早期強化胰島素治療后血清D-乳酸和PCT指標變化，探討其保護腸黏膜屏障的功效，現報道如下。……