Application value of insulin intensive therapy for hyperglycemia after craniocerebral trauma / 中华内分泌外科杂志

ABSTRACT

Objective To investigate the clinical application value of insulin intensive therapy for hyperglycemia after craniocerebral trauma by analyzing its improving effect of illness state and inflammatory cytokines.Methods 62 cases of patients with severe craniocerebral injury were retrospectively studied,in which 31 cases were treated with conventional insulin therapy (normal group),and the other 31 cases were treated with insulin intensive therapy(intensive group).Glasgow coma scale(GCS) score,injury severity score(ISS) and acute physiology and chronic health(APACHE Ⅱ)score were before and after treatment.At the same time,the fasting peripheral blood of each patients were extracted to detect blood sugar concentration and serum inflammatory cytokine levels of IL-6,IL-10,TNF-alpha,hs-CRP.In addition,3 months to 2 years' follow-up were completed after treatment to record the infection rate and mortality rate.Results There was no significant difference in the indexes evaluated between groups before treatment(P ＞ 0.05).After treatment,the GCS score of intensive group was higher than that of normal group while the ISS score and APACHE Ⅱ score were opposite,and all the difference was significant(t =2.448,3.174,5.430 ; P =0.038,0.024,0.001) ; and the ISS score and APACHE Ⅱ score had positive correlation property with blood sugar content(R2 =0.699 9,0.636 4; P =0.016,0.023).At the same time,the blood sugar concentration and serum inflammatory cytokine levels of IL-6,TNF-alpha,hs-CRP of intensive group was lower than those of normal group while the IL-10 level was opposite,and all indicators had statistical difference(t =3.996,2.259,2.659,4.585 ; P =0.014,0.047,0.031,0.002) ; IL-6,TNF-alpha and hs-CRP had positive correlation property with blood sugar content,while IL-10 negative (R2 =0.635 1,0.678 3,0.534 3,0.584 4 ; P =0.022,0.018,0.041,0.038).In addition,the infection rate and mortality rate of intensive group were all lower than those of normal group,with mortality rate got significant difference (x2 =4.846,2.621 ; P =0.028,0.109).Conclusion Our research result shows that insulin intensive treatment could remit hyperglycemia after traumatic brain injury and control the inflammatory reaction rapidly,which contribute to more stable neuroendocrine system and benefit to the prognosis of patients.