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Received:December 13, 2018 Published Online:September 20, 2019
Received:December 13, 2018 Published Online:September 20, 2019
中文摘要: 目的探讨血必净注射液联合胰岛素泵持续皮下注射对糖尿病酮症酸中毒合并感染性休克患者急性生理与慢性健康评分(APACHEⅡ)及血清降钙素原(PCT)水平的影响。方法选取2016年11月至2018年9月收治的糖尿病酮症酸中毒合并感染性休克患者82例,按照治疗方式不同分为对照组(n=41)与研究组(n=41)。常规干预基础上对照组采取胰岛素泵持续皮下注射,研究组于对照组基础上加用血必净注射液,两组均治疗14 d。统计两组症状改善用时及胰岛素用量、治疗前及疗程结束后健康状态评分(APACHEⅡ)、血清炎性因子［PCT、C反应蛋白(CRP)］水平、氧化应激反应指标［谷胱甘肽过氧化物酶(GSH-PX)、丙二醛(MDA)、超氧化物歧化酶(SOD)］水平、不良反应发生率。结果研究组pH值恢复用时、尿酮体转阴用时、血糖达标用时短于对照组,胰岛素用量少于对照组(P<0.05)。两组疗程结束后APACHEⅡ评分较治疗前降低,且研究组低于对照组(P<0.05)。两组疗程结束后血清PCT、CRP水平较治疗前降低,且研究组低于对照组(P<0.05)。两组疗程结束后血清GSH-PX、SOD水平较治疗前增高,MDA水平较治疗前降低,且研究组血清GSH-PX、SOD水平高于对照组,MDA水平低于对照组(P<0.05)。研究组不良反应发生率(17.07%)与对照组(12.20%)间无显著差异(P>0.05)。结论联合采取胰岛素泵持续皮下注射及血必净注射液治疗糖尿病酮症酸中毒合并感染性休克,可有效缓解患者临床症状,减少胰岛素用量,降低血清炎性因子含量,减轻体内氧化应激反应程度,改善患者机体健康状态,且不会增加不良反应发生风险,具有安全性。
Abstract:Objective To investigate the effects of Xuebijing injection combined with continuous subcutaneous insulin pump on acute physiology and chronic health evaluation-Ⅱ(APACHEⅡ) score and serum procalcitonin (PCT) level in patients with diabetic ketoacidosis complicated with septic shock.
Methods Eighty-two patients with diabetic ketoacidosis complicated with septic shock treated from November 2016 to September 2018 were enrolled and divided into control group and study group according to the different treatment methods(n=41,each).On the basis of routine intervention,continuous subcutaneous insulin injection with insulin pump was performed in control group,and Xuebijing injection was added in study group based on the regimen in control group.The treatment was conducted for 14 days in both groups.The time of symptomatic improvement,insulin dosage,APACHEⅡ score,levels of serum inflammatory factors ［PCT,C-reactive protein (CRP)］ and oxidative stress indexes ［glutathione peroxidase (GSH-PX),malondialdehyde (MDA),superoxide dismutase (SOD)］ were detected before and after treatment and analyzed statistically in two groups.The incidence of adverse reactions were observed also. Results The recovery time for medium pH,the turning-to-negative time of urinary ketone,the time of blood glucose level reaching the standard and the dosage of insulin in study group were statistically shorter than those in control group (all P<0.05).APACHEⅡ score and serum PCT and CRP levels decreased after treatment in two groups and were statistically lower in study group than those in control group (all P<0.05).Compared with before treatment,the serum GSH-PX,SOD levels increased,and MDA level decreased in two groups after treatment,and compared with control group,serum GSH-PX,SOD levels increased,and MDA level decreased in study group (all P<0.05).There was no significant difference in the incidence of adverse reactions between study group and control group (17.07% vs 12.20%,P>0.05). Conclusion In the treatment of diabetic ketoacidosis complicated with septic shock,continuous subcutaneous insulin injection with pump combined with Xuebijing injection can effectively alleviate the clinical symptoms of patients,reduce the insulin dosage,the levels of serum inflammatory factors and the degree of oxidative stress reaction in vivo and improve the health status of patients without increasing the risk of adverse reactions.
keywords: Xuebijing injection Insulin Continuous subcutaneous injection Diabetic ketoacidosis Septic shock Acute physiology and chronic health evaluation-Ⅱ Inflammatory factor Oxidative stress reaction
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基金项目:甘肃省科技计划项目(J8JR3RF4230)
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