Shriners Hospitals for Children, Galveston, TX 77550, USA.
Am J Respir Crit Care Med. 2010 Aug 1;182(3):351-9. doi: 10.1164/rccm.201002-0190OC. Epub 2010 Apr 15.
Hyperglycemia and insulin resistance have been shown to increase morbidity and mortality in severely burned patients, and glycemic control appears essential to improve clinical outcomes. However, to date no prospective randomized study exists that determines whether intensive insulin therapy is associated with improved post-burn morbidity and mortality.
To determine whether intensive insulin therapy is associated with improved post-burn morbidity.
A total of 239 severely burned pediatric patients with burns over greater than 30% of their total body surface area were randomized (block randomization 1:3) to intensive insulin treatment (n = 60) or control (n = 179).
Demographics, clinical outcomes, sepsis, glucose metabolism, organ function, and inflammatory, acute-phase, and hypermetabolic responses were determined. Demographics were similar in both groups. Intensive insulin treatment significantly decreased the incidence of infections and sepsis compared with controls (P < 0.05). Furthermore, intensive insulin therapy improved organ function as indicated by improved serum markers, DENVER2 scores, and ultrasound (P < 0.05). Intensive insulin therapy alleviated post-burn insulin resistance and the vast catabolic response of the body (P < 0.05). Intensive insulin treatment dampened inflammatory and acute-phase responses by deceasing IL-6 and acute-phase proteins compared with controls (P < 0.05). Mortality was 4% in the intensive insulin therapy group and 11% in the control group (P = 0.14).
In this prospective randomized clinical trial, we showed that intensive insulin therapy improves post-burn morbidity. Clinical trial registered with www.clinicaltrials.gov (NCT00673309).
高血糖和胰岛素抵抗已被证实会增加严重烧伤患者的发病率和死亡率,血糖控制似乎对改善临床结果至关重要。然而,迄今为止,尚无前瞻性随机研究确定强化胰岛素治疗是否与改善烧伤后发病率有关。
确定强化胰岛素治疗是否与改善烧伤后发病率有关。
将 239 例烧伤面积大于 30%总体表面积的严重烧伤儿科患者随机分组(1:3 区组随机化),接受强化胰岛素治疗(n = 60)或对照组(n = 179)。
确定患者的人口统计学特征、临床结果、脓毒症、葡萄糖代谢、器官功能以及炎症、急性期和高代谢反应。两组患者的人口统计学特征相似。与对照组相比,强化胰岛素治疗显著降低了感染和脓毒症的发生率(P < 0.05)。此外,强化胰岛素治疗通过改善血清标志物、DENVER2 评分和超声结果来改善器官功能(P < 0.05)。强化胰岛素治疗减轻了烧伤后的胰岛素抵抗和机体的巨大分解代谢反应(P < 0.05)。与对照组相比,强化胰岛素治疗通过降低白细胞介素 6 和急性期蛋白来减轻炎症和急性期反应(P < 0.05)。强化胰岛素治疗组的死亡率为 4%,对照组为 11%(P = 0.14)。
在这项前瞻性随机临床试验中,我们表明强化胰岛素治疗可改善烧伤后的发病率。临床试验在 www.clinicaltrials.gov 注册(NCT00673309)。