Email Alerts
RSS

留言板

尊敬的读者、作者、审稿人, 关于本刊的投稿、审稿、编辑和出版的任何问题, 您可以本页添加留言。我们将尽快给您答复。谢谢您的支持!

姓名
邮箱
手机号码
标题
留言内容
验证码

胰岛素强化治疗联合谷氨酰胺对严重烧伤患者营养代谢和炎症反应及血流动力学影响的前瞻性随机对照研究

娄家祺,  厉晔,  崔庆伟,  张盼,  孙晗,  唐浩,  庄梦梦,  孙勇

文章导航 > 中华烧伤与创面修复杂志  > 2021 >  37(9): 821-830
娄家祺, 厉晔, 崔庆伟, 等. 胰岛素强化治疗联合谷氨酰胺对严重烧伤患者营养代谢和炎症反应及血流动力学影响的前瞻性随机对照研究[J]. 中华烧伤杂志, 2021, 37(9): 821-830. DOI: 10.3760/cma.j.cn501120-20210428-00159.
引用本文: 娄家祺, 厉晔, 崔庆伟, 等. 胰岛素强化治疗联合谷氨酰胺对严重烧伤患者营养代谢和炎症反应及血流动力学影响的前瞻性随机对照研究[J]. 中华烧伤杂志, 2021, 37(9): 821-830. DOI: 10.3760/cma.j.cn501120-20210428-00159.
shu
Lou JQ,Li Y,Cui QW,et al.A prospectively randomized controlled study of the effects of intensive insulin therapy combined with glutamine on nutritional metabolism, inflammatory response, and hemodynamics in severe burn patients[J].Chin J Burns,2021,37(9):821-830.DOI: 10.3760/cma.j.cn501120-20210428-00159.
Citation: Lou JQ,Li Y,Cui QW,et al.A prospectively randomized controlled study of the effects of intensive insulin therapy combined with glutamine on nutritional metabolism, inflammatory response, and hemodynamics in severe burn patients[J].Chin J Burns,2021,37(9):821-830.DOI: 10.3760/cma.j.cn501120-20210428-00159.
shu

胰岛素强化治疗联合谷氨酰胺对严重烧伤患者营养代谢和炎症反应及血流动力学影响的前瞻性随机对照研究

doi: 10.3760/cma.j.cn501120-20210428-00159

  • 徐州医科大学附属淮海医院　　解放军陆军第七十一集团军医院烧伤整形科　　221004

基金项目: 

国家自然科学基金面上项目 81772082

详细信息
    通讯作者:

    孙勇，Email：sunyong_97@163.com

A prospectively randomized controlled study of the effects of intensive insulin therapy combined with glutamine on nutritional metabolism, inflammatory response, and hemodynamics in severe burn patients

  • Department of Burns and Plastic Surgery, the 71st Group Army Hospital of PLA Army, Affiliated Huaihai Hospital of Xuzhou Medical University, Xuzhou 221004, China

Funds: 

General Program of National Natural Science Foundation of China 81772082

More Information

    摘要
  • 摘要:   目的  探讨胰岛素强化治疗联合谷氨酰胺对严重烧伤患者营养代谢、炎症反应及血流动力学的影响。  方法  将徐州医科大学附属淮海医院2017年6月—2019年1月收治的32例符合入选标准的严重烧伤患者纳入此前瞻性随机对照研究。按照随机数字表法将患者分为单纯胰岛素常规治疗组、胰岛素常规治疗+谷氨酰胺组、单纯胰岛素强化治疗组与胰岛素强化治疗+谷氨酰胺组，每组8例，各组患者性别依次为男5例、女3例，男4例、女4例，男3例、女5例，男4例、女4例；年龄依次为（35±7）、（36±9）、（33±11）、（38±7）岁。单纯胰岛素常规治疗组患者在常规治疗基础上，采用胰岛素常规治疗控制血糖；胰岛素常规治疗+谷氨酰胺组患者在单纯胰岛素常规治疗组基础上另补充丙氨酰谷氨酰胺14 d以上；单纯胰岛素强化治疗组患者在常规治疗基础上，采用胰岛素强化治疗控制血糖；胰岛素强化治疗+谷氨酰胺组患者在单纯胰岛素强化治疗组基础上另补充丙氨酰谷氨酰胺。分别于治疗1、3、7、14 d，检测4组患者血糖、白蛋白、前白蛋白、白细胞计数、降钙素原和C反应蛋白（CRP）。统计4组患者治疗1、3、7 d心脏指数、每搏量指数（SVI）、全心舒张末期容积指数（GEDVI）、外周血管阻力指数（SVRI）、血管外肺水指数（EVLWI）、肺血管通透性指数（PVPI）。数据处理行Fisher确切概率法检验、单因素方差分析、重复测量方差分析、Bonferroni法。  结果  4组患者均顺利完成研究，无退出病例。治疗3、7、14 d，单纯胰岛素强化治疗组［（5.9±1.3）、（5.8±0.6）、（5.5±0.5）mmol/L］和胰岛素强化治疗+谷氨酰胺组患者血糖［（5.9±1.1）、（5.6±1.1）、（5.2±0.8）mmol/L］均明显低于单纯胰岛素常规治疗组［（9.1±0.5）、（8.4±0.9）、（7.4±1.1）mmol/L，P<0.05］。与单纯胰岛素常规治疗组比，胰岛素常规治疗+谷氨酰胺组、单纯胰岛素强化治疗组、胰岛素强化治疗+谷氨酰胺组患者治疗7、14 d白蛋白明显升高（P<0.05）；与胰岛素强化治疗+谷氨酰胺组比，胰岛素常规治疗+谷氨酰胺组、单纯胰岛素强化治疗组患者治疗14 d白蛋白明显降低（P<0.05）。与单纯胰岛素常规治疗组比，胰岛素常规治疗+谷氨酰胺组、单纯胰岛素强化治疗组患者治疗7、14 d前白蛋白明显升高（P<0.05）；与胰岛素强化治疗+谷氨酰胺组比，单纯胰岛素常规治疗组、胰岛素常规治疗+谷氨酰胺组和单纯胰岛素强化治疗组患者治疗1、7、14 d前白蛋白明显降低（P<0.05）。4组患者治疗1、3、7、14 d白细胞计数、降钙素原、CRP组间两两比较差异均无统计学意义（P>0.05）。治疗3、7 d，胰岛素强化治疗+谷氨酰胺组患者心脏指数、SVI、GEDVI、SVRI明显高于单纯胰岛素常规治疗组（P<0.05），EVLWI、PVPI明显低于单纯胰岛素常规治疗组（P<0.05）。  结论  谷氨酰胺联合胰岛素强化治疗可在患者严重烧伤后改善体内高代谢，减少内源性营养底物的分解与消耗，同时还有助于心功能恢复、维护血流动力学的稳定性。

     

    Abstract:   Objective  To observe the effects of intensive insulin therapy combined with glutamine on nutritional metabolism, inflammatory response, and hemodynamics in severe burn patients.  Methods  Thirty-two severe burn patients who met the inclusion criteria and hospitalized in the Affiliated Huaihai Hospital of Xuzhou Medical University from June 2017 to January 2019 were recruited into a prospectively randomized controlled study. According to the random number table, the patients were divided into conventional insulin therapy alone group, conventional insulin therapy+glutamine group, intensive insulin therapy alone group, and intensive insulin therapy+glutamine group, with 8 patients in each group, with genders of 5 males and 3 females, 4 males and 4 females, 3 males and 5 females, 4 males and 4 females, and ages of (35±7), (36±9), (33±11), and (38±7) years, respectively. Patients in conventional insulin therapy alone group were treated with conventional insulin therapy on the basis of routine treatment to control the blood glucose. Patients in conventional insulin therapy+glutamine group were supplemented with alanyl-glutamine for more than 14 days in addition to the treatment in conventional insulin therapy alone group. Patients in intensive insulin therapy alone group were treated with intensive insulin therapy on the basis of routine treatment to control the blood glucose. Patients in intensive insulin therapy+glutamine group were supplemented with alanyl-glutamine in addition to the treatment in intensive insulin therapy alone group. On treatment day (TD) 1, 3, 7, and 14, the blood glucose, albumin, prealbumin, white blood cell count, procalcitonin (PCT), and C-reactive protein (CRP) of patients in the 4 groups were detected. The cardiac index (CI), stroke volume index (SVI), global end-diastolic volume index (GEDVI), systemic vascular resistance index (SVRI), extravascular lung water index (EVLWI), and pulmonary vascular permeability index (PVPI) of patients in the 4 groups on TD 1, 3, and 7 were measured. Data were statistically analyzed with Fisher′s exact probability test, one-way analysis of variance, analysis of variance for repeated measurement, and Bonferroni method.  Results  All patients in the 4 groups successfully completed the study, and there were no withdrawal cases. On TD 3, 7, and 14, the blood glucose of patients in intensive insulin therapy alone group ((5.9±1.3), (5.8±0.6), (5.5±0.5) mmol/L) and intensive insulin therapy+glutamine group ((5.9±1.1), (5.6±1.1), (5.2±0.8) mmol/L) were significantly lower than those in conventional insulin therapy alone group ((9.1±0.5), (8.4±0.9), (7.4±1.1) mmol/L, P<0.05). Compared with those in conventional insulin therapy alone group, the levels of albumin of patients in conventional insulin therapy+glutamine group, intensive insulin therapy alone group, and intensive insulin therapy+glutamine group were significantly increased on TD 7 and 14 (P<0.05). Compared with the level of albumin of patients in intensive insulin therapy+glutamine group, the levels of albumin of patients in conventional insulin therapy+glutamine group and intensive insulin therapy alone group were significantly decreased on TD 14 (P<0.05). Compared with those in conventional insulin therapy alone group, the levels of prealbumin of patients in conventional insulin therapy+glutamine group and intensive insulin therapy alone group were significantly increased on TD 7 and 14 (P<0.05). Compared with those in intensive insulin therapy+glutamine group, the levels of prealbumin of patients in intensive insulin therapy alone group and conventional insulin therapy+glutamine group were significantly decreased on TD 1, 7, and 14 (P<0.05). There were no statistically significant differences in the white blood cell count, PCT, and CRP of patients in the 4 groups in pairwise comparison between groups on TD 1, 3, 7, and 14 (P>0.05). On TD 3 and 7, the levels of cardiac index, SVI, GEDVI, and SVRI of patients in intensive insulin therapy+glutamine group were significantly higher than those in conventional insulin therapy alone group (P<0.05), while the levels of EVLWI and PVPI were significantly lower than those in conventional insulin therapy alone group (P<0.05).  Conclusions  Glutamine combined with intensive insulin therapy can improve the hypermetabolism in patients after severe burns, reduce the decomposition and consumption of endogenous nutrient substrates, and at the same time help the recovery of cardiac function and maintenance of hemodynamic stability.

     

    • HTML全文

  • 参考文献(36)

    [1] JeschkeMG,van BaarME,ChoudhryMA,et al.Burn injury[J].Nat Rev Dis Primers,2020,6(1):11.DOI: 10.1038/s41572-020-0145-5.
    [2] SommerhalderC,BlearsE,MurtonAJ,et al.Current problems in burn hypermetabolism[J].Curr Probl Surg,2020,57(1):100709.DOI: 10.1016/j.cpsurg.2019.100709.
    [3] CampbellJM, AdanichkinN, KurmisR, et al. Intensive insulin therapy, insulin sensitisers and insulin secretagogues for burns: a systematic review of effectiveness and safety[J]. Burns, 2018, 44(6):1377-1394. DOI: 10.1016/j.burns.2017.09.013.
    [4] 厉晔, 王朋, 李翠洁, 等. 乌司他丁联合谷氨酰胺对严重烧伤患者早期血流动力学的影响[J]. 中华烧伤杂志, 2020, 36(2):110-116. DOI: 10.3760/cma.j.issn.1009-2587.2020.02.006.
    [5] WischmeyerPE. Glutamine in burn injury[J]. Nutr Clin Pract, 2019, 34(5):681-687. DOI: 10.1002/ncp.10362.
    [6] BarrettLW, FearVS, WaithmanJC, et al. Understanding acute burn injury as a chronic disease[J/OL]. Burns Trauma, 2019,7:23[2021-08-18].https://pubmed.ncbi.nlm.nih.gov/31534977/.DOI: 10.1186/s41038-019-0163-2.
    [7] 彭曦. 烧伤临床营养新视角[J]. 中华烧伤杂志, 2019, 35(5):321-325. DOI: 10.3760/cma.j.issn.1009-2587.2019.05.001.
    [8] BadoiuSC, MiricescuD, Stanescu-SpinuII, et al. Glucose metabolism in burns-what happens?[J]. Int J Mol Sci, 2021, 22(10):5159.DOI: 10.3390/ijms22105159.
    [9] ScheenM, GiraudR, BendjelidK. Stress hyperglycemia, cardiac glucotoxicity, and critically ill patient outcomes current clinical and pathophysiological evidence[J]. Physiol Rep, 2021, 9(2):e14713. DOI: 10.14814/phy2.14713.
    [10] 李玲玲, 陶有为, 扈俊华, 等. 重型颅脑损伤合并高血糖术后短期胰岛素强化治疗的效果分析[J]. 中国临床神经外科杂志, 2020, 25(6):368-370. DOI: 10.13798/j.issn.1009-153X.2020.06.010.
    [11] ClarkA, ImranJ, MadniT, et al. Nutrition and metabolism in burn patients[J/OL]. Burns Trauma, 2017,5:11[2021-08-20]. https://pubmed.ncbi.nlm.nih.gov/28428966/. DOI: 10.1186/s41038-017-0076-x.
    [12] NavickisRJ, GreenhalghDG, WilkesMM. Albumin in burn shock resuscitation: a meta-analysis of controlled clinical studies[J]. J Burn Care Res, 2016,37(3):e268-278.DOI: 10.1097/BCR.0000000000000201.
    [13] JeschkeMG, KleinD, HerndonDN. Insulin treatment improves the systemic inflammatory reaction to severe trauma[J]. Ann Surg, 2004, 239(4):553-560. DOI: 10.1097/01.sla.0000118569.10289.ad.
    [14] 彭曦. 重视谷氨酰胺在烧伤临床的规范应用[J]. 肠外与肠内营养, 2021,28(1):1-4. DOI: 10.16151/j.1007-810x.2021.01.001.
    [15] van ZantenARH, DhaliwalR, GarrelD, et al. Enteral glutamine supplementation in critically ill patients: a systematic review and meta-analysis[J]. Crit Care, 2015, 19(1):294. DOI: 10.1186/s13054-015-1002-x.
    [16] D'AbbondanzaJA, ShahrokhiS. Burn infection and burn sepsis[J]. Surg Infect (Larchmt), 2021, 22(1):58-64. DOI: 10.1089/sur.2020.102.
    [17] 夏照帆,胡晓燕,王光毅,等.烧伤休克的发病机制和病理生理[J/CD].中华损伤与修复杂志:电子版,2007,2(6):326-328.
    [18] GillenwaterJ, GarnerW. Acute fluid management of large burns: pathophysiology, monitoring, and resuscitation[J]. Clin Plast Surg, 2017,44(3):495-503. DOI: 10.1016/j.cps.2017.02.008.
    [19] 谢锋,柴家科,胡泉,等.烧冲复合伤大鼠心肌损伤及钙蛋白酶的变化规律[J].中华医学杂志,2017,97(46):3652-3657.DOI: 10.3760/cma.j.issn.0376-2491.2017.46.012.
    [20] Lipinska-GedigaM.Sepsis and septic shock-is a microcirculation a main player?[J].Anaesthesiol Intensive Ther,2016,48(4):261-265.DOI: 10.5603/AIT.a2016.0037.
    [21] CaldwellA,MorickJN,JentschAM,et al.Impact of insulin on the intestinal microcirculation in a model of sepsis-related hyperglycemia[J].Microvasc Res,2018,119:117-128.DOI: 10.1016/j.mvr.2018.05.004.
    [22] 吕根法,郑宏智,石宏伟,等.胰岛素对烧伤后心肌细胞损伤保护的初步研究[J].中华危重病急救医学,2020,32(7):824-827.DOI: 10.3760/cma.j.cn121430-20200528-00420.
    [23] RaeL,FidlerP,GibranN.The physiologic basis of burn shock and the need for aggressive fluid resuscitation[J].Crit Care Clin,2016,32(4):491-505.DOI: 10.1016/j.ccc.2016.06.001.
    [24] 张勤,汤耀卿.重视烧伤早期液体复苏循环状态研究[J].中华烧伤杂志,2018,34(4):193-196.DOI: 10.3760/cma.j.issn.1009-2587.2018.04.001.
    [25] LittonE,MorganM.The PiCCO monitor: a review[J].Anaesth Intensive Care,2012,40(3):393-409.DOI: 10.1177/0310057X1204000304.
    [26] GongC,ZhangF,LiL,et al.The variation of hemodynamic parameters through PiCCO in the early stage after severe burns[J].J Burn Care Res,2017,38(6):e966-e972.DOI: 10.1097/BCR.0000000000000533.
    [27] ZhangY,YanH,LvSG,et al.Effects of glycyl-glutamine dipeptide supplementation on myocardial damage and cardiac function in rats after severe burn injury[J].Int J Clin Exp Pathol,2013,6(5):821-830.
    [28] RiehleC,AbelED.Insulin regulation of myocardial autophagy[J].Circ J,2014,78(11):2569-2576.DOI: 10.1253/circj.cj-14-1080.
    [29] 张家平, 向飞, 童大力, 等. 限制性液体管理策略对严重烧伤患者早期肺功能影响的对比研究[J]. 中华烧伤杂志, 2012,28(3):165-169. DOI: 10.3760/cma.j.issn.1009-2587.2012.03.002.
    [30] TapkingC, PoppD, HerndonDN, et al. Cardiac dysfunction in severely burned patients: current understanding of etiology, pathophysiology, and treatment[J]. Shock, 2020, 53(6):669-678. DOI: 10.1097/SHK.0000000000001465.
    [31] NemetI, SahaPP, GuptaN, et al. A cardiovascular disease-linked gut microbial metabolite acts via adrenergic receptors[J]. Cell, 2020,180(5):862-877.e22. DOI: 10.1016/j.cell.2020.02.016.
    [32] OlverTD, GrunewaldZI, GhiaroneT, et al. Persistent insulin signaling coupled with restricted PI3K activation causes insulin-induced vasoconstriction[J]. Am J Physiol Heart Circ Physiol, 2019,317(5):H1166-H1172. DOI: 10.1152/ajpheart.00464.2019.
    [33] TakatoriS. Function of perivascular nerves in insulin resistance- induced hypertension[J]. Yakugaku Zasshi, 2017, 137(11):1367-1371. DOI: 10.1248/yakushi.17-00149.
    [34] WangWY,XuN,YuXF,et al.Changes of extravascular lung water as an independent prognostic factor for early developed ARDS in severely burned patients[J].J Burn Care Res,2020,41(2):402-408.DOI: 10.1093/jbcr/irz189.
    [35] TanitaMT, CapelettiMM, MoreiraTA, et al. Risk factors for acute respiratory distress syndrome in severe burns: prospective cohort study[J]. Int J Burns Trauma, 2020, 10(1):1-14.
    [36] LuoHM, DuMH, LinZL, et al. Ulinastatin suppresses burn- induced lipid peroxidation and reduces fluid requirements in a swine model[J]. Oxid Med Cell Longev, 2013,2013:904370. DOI: 10.1155/2013/904370.

  • 表1  4组严重烧伤患者一般资料比较

    组别例数性别（例）年龄（岁，x¯±s）烧伤面积（%TBSA，x¯±s）烧伤指数（%TBSA，x¯±s）
    男女总面积Ⅲ度面积
    单纯胰岛素常规治疗组85335±748±1128±738±6
    胰岛素常规治疗+谷氨酰胺组84436±946±1332±640±6
    单纯胰岛素强化治疗组83533±1151±833±842±7
    胰岛素强化治疗+谷氨酰胺组84438±750±729±739±4
    F值—0.2850.2891.2590.763
    P值>0.05>0.05>0.05>0.05>0.05
    注：“—”表示无此统计量值；TBSA为体表总面积
    下载: 导出CSV

    表2  4组严重烧伤患者治疗各时间点血糖比较（mmol/L，x¯±s）

    组别例数1 d3 d7 d14 d
    单纯胰岛素常规治疗组89.6±1.29.1±0.58.4±0.97.4±1.1
    胰岛素常规治疗+谷氨酰胺组88.5±0.88.5±0.67.1±1.26.0±0.9
    单纯胰岛素强化治疗组89.3±0.55.9±1.3a5.8±0.6a5.5±0.5a
    胰岛素强化治疗+谷氨酰胺组89.2±0.95.9±1.1a5.6±1.1a5.2±0.8a
    F值3.13734.66018.50715.933
    P值<0.05<0.01<0.01<0.01
    注：成人空腹血糖正常值为3.9~6.1 mmol/L；处理因素主效应，F=49.598，P<0.01；时间因素主效应，F=62.512，P<0.01；两者交互作用，F=5.119，P<0.01；F值、P值为组间各时间点总体比较所得；与单纯胰岛素常规治疗组比较，aP<0.05
    下载: 导出CSV

    表3  4组严重烧伤患者治疗各时间点白蛋白比较（g/L，x¯±s）

    组别例数1 d3 d7 d14 d
    单纯胰岛素常规治疗组823.6±22.4±24.2±25.3±
    5.45.67.33.0
    胰岛素常规治疗+谷氨酰胺组824.2±23.2±28.4±30.4±
    7.26.53.4a3.6ab
    单纯胰岛素强化治疗组823.8±23.2±29.1±31.0±
    6.38.61.6a2.7ab
    胰岛素强化治疗+谷氨酰胺组824.0±24.8±31.4±36.8±
    4.15.42.6a2.9a
    F值0.0140.1693.83319.069
    P值<0.01<0.01<0.05<0.01
    注：白蛋白正常值>35 g/L；处理因素主效应，F=5.794，P<0.01；时间因素主效应，F=39.626，P<0.01；两者交互作用，F=3.636，P<0.05；F值、P值为组间各时间点总体比较所得；与单纯胰岛素常规治疗组比较，aP<0.05；与胰岛素强化治疗+谷氨酰胺组比较，bP<0.05
    下载: 导出CSV

    表4  4组严重烧伤患者治疗各时间点前白蛋白比较（mg/L，x¯±s）

    组别例数1 d3 d7 d14 d
    单纯胰岛素常规治疗组8154±10a113±1582±9a108±8a
    胰岛素常规治疗+谷氨酰胺组8151±15a118±14104±13ab159±24ab
    单纯胰岛素强化治疗组8155±24a116±16108±16ab173±43ab
    胰岛素强化治疗+谷氨酰胺组8157±20141±17129±20170±58
    F值0.1335.29212.63218.977
    P值<0.01<0.05<0.01<0.01
    注：前白蛋白正常值为280~360 mg/L；处理因素主效应，F=14.586，P<0.01；时间因素主效应，F=2.388，P>0.05；两者交互作用，F=17.254，P<0.01；F值、P值为组间各时间点总体比较所得；与胰岛素强化治疗+谷氨酰胺组比较，aP<0.05；与单纯胰岛素常规治疗组比较，bP<0.05
    下载: 导出CSV

    表5  4组严重烧伤患者治疗各时间点白细胞计数比较（×109/L，x¯±s）

    组别例数1 d3 d7 d14 d
    单纯胰岛素常规治疗组820.9±13.4±13.3±13.1±
    2.81.10.92.6
    胰岛素常规治疗+谷氨酰胺组820.2±13.9±13.2±12.2±
    3.22.20.70.6
    单纯胰岛素强化治疗组818.8±12.6±14.0±12.9±
    7.42.01.61.5
    胰岛素强化治疗+谷氨酰胺组820.2±12.3±12.7±13.0±
    5.61.01.91.4
    F值0.5341.1480.7930.825
    P值<0.01<0.01<0.01<0.01
    注：成人白细胞计数正常值为（4.0~10.0）×109/L；处理因素主效应，F=1.593，P>0.05；时间因素主效应，F=47.331，P<0.01；两者交互作用，F=0.173，P>0.05；F值、P值为组间各时间点总体比较所得
    下载: 导出CSV

    表6  4组严重烧伤患者治疗各时间点降钙素原比较（ng/mL，x¯±s）

    组别例数1 d3 d7 d14 d
    单纯胰岛素常规治疗组86.00±3.67±1.07±0.66±
    0.560.310.160.32
    胰岛素常规治疗+谷氨酰胺组86.12±3.81±0.96±0.94±
    1.380.410.170.15
    单纯胰岛素强化治疗组85.91±3.62±0.94±0.84±
    0.900.260.150.24
    胰岛素强化治疗+谷氨酰胺组85.72±3.34±0.99±0.92±
    0.670.410.130.32
    F值0.2622.5571.0572.012
    P值<0.01<0.01<0.01<0.01
    注：降钙素原正常值为<0.5 ng/mL；处理因素主效应，F=0.318，P>0.05；时间因素主效应，F=998.094，P<0.01；两者交互作用，F=1.018，P>0.05；F值、P值为组间各时间点总体比较所得
    下载: 导出CSV

    表7  4组严重烧伤患者治疗各时间点C反应蛋白比较（mg/L，x¯±s）

    组别例数1 d3 d7 d14 d
    单纯胰岛素常规治疗组891±3478±871±1843±10
    胰岛素常规治疗+谷氨酰胺组881±2377±1265±1538±14
    单纯胰岛素强化治疗组872±2384±1175±1649±20
    胰岛素强化治疗+谷氨酰胺组868±1577±1070±1350±25
    F值1.4330.7800.5080.700
    P值<0.01<0.01<0.01<0.01
    注：C反应蛋白正常值为0~5 mg/L；处理因素主效应，F=0.806，P>0.05；时间因素主效应，F=40.417，P<0.01；两者交互作用，F=1.748，P>0.05；F值、P值为组间各时间点总体比较所得
    下载: 导出CSV

    表8  4组严重烧伤患者治疗各时间点心脏指数比较（L·min-1·m-2，x¯±s）

    组别例数1 d3 d7 d
    单纯胰岛素常规治疗组83.24±0.434.67±0.496.21±0.68
    胰岛素常规治疗+谷氨酰胺组83.13±0.165.39±1.146.39±1.12
    单纯胰岛素强化治疗组83.28±0.335.21±0.416.32±0.58
    胰岛素强化治疗+谷氨酰胺组83.49±0.245.82±0.44a6.52±0.43a
    F值1.9643.7990.275
    P值<0.01<0.01<0.01
    注：心脏指数正常值为3.0~5.0 L·min-1·m-2；处理因素主效应，F=3.560，P<0.05；时间因素主效应，F=207.235，P<0.01；两者交互作用，F=1.067，P>0.05；F值、P值为组间各时间点总体比较所得；与单纯胰岛素常规治疗组比较，aP<0.05
    下载: 导出CSV

    表9  4组严重烧伤患者治疗各时间点每搏量指数比较（mL/m2，x¯±s）

    组别例数1 d3 d7 d
    单纯胰岛素常规治疗组832.1±2.343.3±7.954.8±3.9
    胰岛素常规治疗+谷氨酰胺组834.8±7.651.2±13.255.3±2.6
    单纯胰岛素强化治疗组837.1±6.245.3±6.754.9±3.2
    胰岛素强化治疗+谷氨酰胺组832.1±5.255.6±5.3a61.1±1.5a
    F值1.4623.2858.752
    P值<0.01<0.05<0.01
    注：每搏量指数正常值为40~60 mL/m2；处理因素主效应，F=4.134，P<0.01；时间因素主效应，F=106.187，P<0.01；两者交互作用，F=2.717，P<0.05；F值、P值为组间各时间点总体比较所得；与单纯胰岛素常规治疗组比较，aP<0.05
    下载: 导出CSV

    表10  4组严重烧伤患者治疗各时间点全心舒张末期容积指数比较（mL/m2，x¯±s）

    组别例数1 d3 d7 d
    单纯胰岛素常规治疗组8618±175733±124812±103
    胰岛素常规治疗+谷氨酰胺组8671±181803±69850±121
    单纯胰岛素强化治疗组8640±192768±101841±135
    胰岛素强化治疗+谷氨酰胺组8651±125872±77a845±112a
    F值0.0763.1220.168
    P值<0.01<0.05<0.01
    注：全心舒张末期容积指数正常值为600~800 mL/m2；处理因素主效应，F=1.084，P<0.05；时间因素主效应，F=21.610，P<0.01；两者交互作用，F=0.401，P<0.01；F值、P值为组间各时间点总体比较所得；与单纯胰岛素常规治疗组比较，aP<0.05
    下载: 导出CSV

    表11  4组严重烧伤患者治疗各时间点外周血管阻力指数比较（dyn·s·cm-5·m2，x¯±s）

    组别例数1 d3 d7 d
    单纯胰岛素常规治疗组82 187±1441 528±191988±145
    胰岛素常规治疗+谷氨酰胺组82 342±3441 592±1441 102±113
    单纯胰岛素强化治疗组82 204±2231 449±1331 125±103
    胰岛素强化治疗+谷氨酰胺组82 201±1791 783±253a1 201±141a
    F值0.7624.6603.850
    P值<0.01<0.05<0.05
    注：外周血管阻力指数正常值为1 700~2 400 dyn·s·cm-5·m2；处理因素主效应，F=3.776，P<0.05；时间因素主效应，F=290.214，P<0.01；两者交互作用，F=1.872，P>0.05；F值、P值为组间各时间点总体比较所得；与单纯胰岛素常规治疗组比较，aP<0.05
    下载: 导出CSV

    表12  4组严重烧伤患者治疗各时间点血管外肺水指数比较（mL/kg，x¯±s）

    组别例数1 d3 d7 d
    单纯胰岛素常规治疗组86.6±0.57.2±0.67.8±0.5
    胰岛素常规治疗+谷氨酰胺组86.3±0.76.4±1.37.2±0.9
    单纯胰岛素强化治疗组86.3±0.46.7±0.87.4±0.6
    胰岛素强化治疗+谷氨酰胺组86.4±0.65.7±0.8a6.6±0.5a
    F值0.3703.9984.583
    P值<0.05<0.05<0.05
    注：血管外肺水指数正常值为3~7 mL/kg；处理因素主效应，F=7.278，P<0.01；时间因素主效应，F=13.412，P<0.01；两者交互作用，F=1.418，P>0.05；F值、P值为组间各时间点总体比较所得；与单纯胰岛素常规治疗组比较，aP<0.05
    下载: 导出CSV

    表13  4组严重烧伤患者治疗各时间点肺血管通透性指数比较（x¯±s）

    组别例数1 d3 d7 d
    单纯胰岛素常规治疗组81.68±0.191.62±0.211.31±0.22
    胰岛素常规治疗+谷氨酰胺组81.63±0.101.51±0.171.19±0.17
    单纯胰岛素强化治疗组81.57±0.211.49±0.111.17±0.15
    胰岛素强化治疗+谷氨酰胺组81.58±0.141.31±0.09a0.91±0.18a
    F值0.8755.3286.685
    P值<0.05<0.05<0.05
    注：肺血管通透性指数正常值为1.0~3.0；处理因素主效应，F=10.508，P<0.01；时间因素主效应，F=67.452，P<0.01；两者交互作用，F=1.382，P>0.05；F值、P值为组间各时间点总体比较所得；与单纯胰岛素常规治疗组比较，aP<0.05
    下载: 导出CSV
    • 相关文章
    • 施引文献
  • 资源附件(0)
  • 加载中
表(13)
计量
  • 文章访问数:  2907
  • HTML全文浏览量:  116
  • PDF下载量:  48
  • 被引次数: 0
出版历程
  • 收稿日期:  2021-04-28

目录

    /

    返回文章
    返回

    版权所有 中华医学会 中华烧伤杂志京ICP备07035254号-14

    E-mail：shaoshangzazhi@163.com

    网址：https://zhsszz.xml-journal.net/

    本系统由 北京仁和汇智信息技术有限公司 开发    百度统计