中华外科杂志
中華外科雜誌
중화외과잡지
CHINESE JOURNAL OF SURGERY
2008年
12期
936-938
,共3页
王超%张彤彦%许媛%赵京阳%何伟%李彤%周华%赵栋
王超%張彤彥%許媛%趙京暘%何偉%李彤%週華%趙棟
왕초%장동언%허원%조경양%하위%리동%주화%조동
重症监护%受体,胰岛素%应激性高血糖%强化胰岛素治疗
重癥鑑護%受體,胰島素%應激性高血糖%彊化胰島素治療
중증감호%수체,이도소%응격성고혈당%강화이도소치료
Intensive care%Receptor,insulin%Stress induced hyperglycemia%Intensive insulin therapy
目的 探讨术后重症患者胰岛素受体的变化规律及严格血糖控制对其功能的影响.方法 以19例APACHEⅡ评分≥10分的术后重症患者为研究对象,根据血糖控制目标随机分为严格血糖控制组(控制血糖在4.4～6.7 mmol/L)和高血糖组(控制血糖在8.3～10.0 mmol/L).持续静脉泵入胰岛素控制血糖,记录血糖值和胰岛素用量.同时测定红细胞胰岛素受体(InsR)数目和亲和常数(K).结果 全部患者均出现血糖升高;术后第1天的红细胞胰岛素受体数目及亲和常数均明显低于正常,第2、4、7天逐渐恢复,但仍低于正常水平;APACHEⅡ评分≥15分者,第1天红细胞胰岛素受体数目、亲和常数明显低于APACHEⅡ评分＜15分的患者;平均每日胰岛素用量随红细胞胰岛素受体的恢复而逐渐减少,两者呈负相关;严格血糖控制组红细胞胰岛素受体数目和亲和常数的恢复明显好于高血糖组.两组间每日平均胰岛素用量无明显差异.结论 胰岛素受体的改变在应激性高血糖的发生中起一定作用,血糖正常化可能有助于胰岛素受体的恢复.
目的 探討術後重癥患者胰島素受體的變化規律及嚴格血糖控製對其功能的影響.方法 以19例APACHEⅡ評分≥10分的術後重癥患者為研究對象,根據血糖控製目標隨機分為嚴格血糖控製組(控製血糖在4.4～6.7 mmol/L)和高血糖組(控製血糖在8.3～10.0 mmol/L).持續靜脈泵入胰島素控製血糖,記錄血糖值和胰島素用量.同時測定紅細胞胰島素受體(InsR)數目和親和常數(K).結果 全部患者均齣現血糖升高;術後第1天的紅細胞胰島素受體數目及親和常數均明顯低于正常,第2、4、7天逐漸恢複,但仍低于正常水平;APACHEⅡ評分≥15分者,第1天紅細胞胰島素受體數目、親和常數明顯低于APACHEⅡ評分＜15分的患者;平均每日胰島素用量隨紅細胞胰島素受體的恢複而逐漸減少,兩者呈負相關;嚴格血糖控製組紅細胞胰島素受體數目和親和常數的恢複明顯好于高血糖組.兩組間每日平均胰島素用量無明顯差異.結論 胰島素受體的改變在應激性高血糖的髮生中起一定作用,血糖正常化可能有助于胰島素受體的恢複.
목적 탐토술후중증환자이도소수체적변화규률급엄격혈당공제대기공능적영향.방법 이19례APACHEⅡ평분≥10분적술후중증환자위연구대상,근거혈당공제목표수궤분위엄격혈당공제조(공제혈당재4.4～6.7 mmol/L)화고혈당조(공제혈당재8.3～10.0 mmol/L).지속정맥빙입이도소공제혈당,기록혈당치화이도소용량.동시측정홍세포이도소수체(InsR)수목화친화상수(K).결과 전부환자균출현혈당승고;술후제1천적홍세포이도소수체수목급친화상수균명현저우정상,제2、4、7천축점회복,단잉저우정상수평;APACHEⅡ평분≥15분자,제1천홍세포이도소수체수목、친화상수명현저우APACHEⅡ평분＜15분적환자;평균매일이도소용량수홍세포이도소수체적회복이축점감소,량자정부상관;엄격혈당공제조홍세포이도소수체수목화친화상수적회복명현호우고혈당조.량조간매일평균이도소용량무명현차이.결론 이도소수체적개변재응격성고혈당적발생중기일정작용,혈당정상화가능유조우이도소수체적회복.
Objective To investigate the changes of insulin receptor in critical ill patients with stress hyperglycemia and the effect of intensive glucose control on it.Methods Nineteen adult patients were admitted to surgical intensive care unit(SICU)and randomly assigned into two groups:intensive glucose controlled group(to control glucose at 4.4-6.7 mmol/L)and hyperglycemia group(to control glucose at 8.3-10.0 mmo]/L).Blood glucose Was controlled with using continuing insulin infusion.The expression of insulin receptors(InsR)of pefipheral erythrocyte was detected by radioligand assay methods on the morning of day1,2,4,7 after admitted to SICU.Daily usage of insulin and APACHE Ⅱ score were recorded.The correlation of number and affinity constant of erythrocyte insulin receptors with daily dosage of insulin and APACHE Ⅱ were analyzed Results The number and affinity constant of erythrocyte insulin reeeptors was decreased significantly in day 1 and 2 in both groups,and recovered gradually in day 4 and 7,and significant difierence was found between the patients with APACHEⅡ≥15 and those with APACHE Ⅱ＜15.The number and affinity constant of erythrocyte insulin receptor recovered more quickly in intensive glucose controlled group than in hypeglycemia group.Conclusions It indicates that decline of erythrocyte insulin receptor and its function are observed in SICU patients.and it plays a role in stress induced hyperglycemia.Intensive insulin therapy and glucose control may improve function recovery of insulin receptor.
