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Volume 37 Issue 9
Sep.  2021
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Article Navigation >  CHINESE JOURNAL OF BURNS AND WOUNDS  > 2021  >  37(9): 821-830
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

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

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

  • 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

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    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.

     

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    • References(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.
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