摘要
目的探讨重组人碱性成纤维细胞生长因子(rh-bFGF)联合胰岛素强化治疗深Ⅱ度烧伤伴应激性高血糖的效果及对机体代谢、免疫指标的影响。方法选取我院2017年2月—2019年2月收治的深Ⅱ度烧伤伴应激性高血糖97例,采用随机数字表法分为观察组48例和对照组49例,观察组在基础治疗上给予rh-bFGF联合胰岛素强化治疗,对照组在基础治疗上给予rh-bFGF联合中性胰岛素治疗。术后14d观察两组临床疗效,比较两组创面愈合时间,治疗前及治疗后第3、7、14日两组血糖、前白蛋白、尿3-甲基组氨酸(3-MH)和CD3+、CD4+、CD8+、CD4+/CD8+值,以及观察两组治疗期间不良反应发生情况。结果治疗后观察组总有效率为91.67%高于对照组的73.47%(P<0.05)。观察组创面愈合时间为(19.83±2.21)d短于对照组的(23.77±2.96)d,差异有统计学意义(P<0.05)。治疗后两组空腹血糖变化较平稳,均较治疗前降低(P<0.05),且观察组治疗后3、7、14d空腹血糖均低于对照组(P<0.05)。治疗后两组前白蛋白水平均升高,且观察组治疗后3、7、14d前白蛋白水平亦高于对照组,差异均有统计学意义(P<0.05)。治疗后观察组尿3-MH水平降低,且观察组治疗后3、7、14d尿3-MH水平低于对照组,差异均有统计学意义(P<0.05)。两组治疗后CD3+、CD4+、CD8+、CD4+/CD8+水平均较治疗前改善(P<0.05);观察组治疗后同时间点CD4+/CD8+水平较对照组改善明显(P<0.05)。两组治疗期间均未出现严重不良反应。结论rh-bFGF联合胰岛素强化治疗深Ⅱ度烧伤伴应激性高血糖可显著提高临床效果,缩短创面愈合时间,并可纠正机体代谢紊乱状态,改善机体免疫功能,且治疗安全性较好。
ObjectiveTo investigate the effect of recombinant human basic fibroblast growth factor ( rh-bFGF ) combined with insulin intensive therapy on deep second degree burn patients with stress hyperglycemia and its influence on metabolism and immune indexes.MethodsA total of 97 cases of deep second-degree burn with stress hyperglycemia who were treated in our hospital from February 2017 to February 2019 were selected.According to random number table method, they were divided into the observation group ( n =48) and the control group ( n =49).The observation group was given rh-bFGF combined with insulin intensive therapy after basic treatment, and the control group was treated with rh-bFGF combined with neutral insulin after basic treatment.The clinical efficacy of the two groups was observed 14 d after operation, and the average healing time of the wound in the two groups was compared.The blood sugar, prealbumin, urinary 3-methylhistidine (3-MH), CD 3 +,CD 4 +,CD 8 +, and CD 4 +/CD 8 + levels before and at 3, 7, and 14 d after treatment, and the occurrence of adverse reactions during treatment were observed in the two groups.ResultsThe total effective rate was 91.67% in the observation group, which was higher than that (73.47%) of the control group ( P <0.05).The average healing time of wounds in the observation group was (19.83±2.21) d, which was shorter than (23.77±2.96) d of the control group ( P <0.05).After treatment, the change of fasting blood glucose was stable, which was lower than that before treatment ( P <0.05), and fasting blood glucose in the observation group was lower than that in the control group at 3, 7, and 14 d after treatment ( P <0.05).After treatment, the levels of prealbumin in the two groups were higher, which was higher in observation group than in the control group at 3, 7, and 14 d after treatment.The difference was statistically significant ( P <0.05).The level of urinary 3-MH was decreased in the observation group after treatment, which was lower in the observation group than in the control group at 3, 7, and 14 d after treatment ( P <0.05).After treatment, levels of CD 3 +, CD 4 +, CD 8 +, CD 4 +/CD 8 + in both groups were better than those before treatment ( P <0.05).The level of CD 4 +/CD 8 + at the same time point after treatment was significantly improved in the observation group compared with the control group( P <0.05).No serious adverse reactions occurred during the treatment.ConclusionThe rh-bFGF combined with insulin intensive therapy can significantly improve clinical effect, shorten wound healing time, correct metabolic disorder and improve immune function in deep second degree burn patients with stress hyperglycemia, and the treatment is safe.
作者
张冀北
李慧
张春华
张丽
王浩
王峻岭
ZHANG Ji-bei;LI Hui;ZHANG Chun-hua;ZHANG Li;WANG Hao;WANG Jun-ling(Department of Burn Plastic Surgery,the Central Hospital of Cangzhou,Cangzhou,Hebei 061000,China)
出处
《临床误诊误治》
2019年第10期32-37,共6页
Clinical Misdiagnosis & Mistherapy
基金
沧州市重点研发计划指导项目(172302011)
