Study On Short-term Insulin Intensive Control Of Stress Hyperglycemia In Severe Burn Patients

Background:Burn is one of the most common traumatic diseases in clinical practice.It has a serious impact on the internal environment of the body,causing pathological and physiological changes in various systems of the human body,resulting in functional abnormalities,often manifested as changes in various indicators such as immune function and inflammatory factors.Burns can also cause a stress response in the body,resulting in stress hyperglycemia(SH),which is one of the most significant manifestations after burns.SH not only aggravates the inflammatory response,but also inhibits the immune response.At present,there are many studies on the control of stress hyperglycemia by insulin fortification in critically ill patients,but there are few reports on the application of insulin fortification in severe burns,and there is no unified standard for the range of blood glucose control.In this study,we analysis the correlation between blood glucose and inflammatory factors and immune function in patients with severe burn,and the effect of insulin intensive treatment on the blood glucose control level of stress hyperglycemia.It provides a theoretical basis for the treatment of stress hyperglycemia in clinical burn patients,and studies the best standard of blood glucose control,to improve the treatment level of severe burn patients.Methods:A sample size of 134 severe burns patients were chosen at Department of Burns and Plastic Surgery of First Affiliated Hospital of Chengdu Medical College,over the period of January 2012 to December 2017,to serve as severe burn group;while 60healthy volunteers after physical examination from the First Affiliated Hospital of Chengdu Medical College served as control group.The fasting blood glucose level(FPG),inflammatory factors,and T cell levels for both two groups were studied,and the differences between FPG,inflammatory factors,and T cell levels were compared between the two groups.The patients in the experimental group were divided into normal blood glucose group(FPG<7.0 mmol/L)with 16 cases and high blood glucose group(FPG?7.0 mmol/L)with 118 cases according to the FPG concentration.Besides,a sample size of 62 stress hyperglycemia patients of severe burns were chosen at Department of Burns and Plastic Surgery of First Affiliated Hospital of Chengdu Medical College,over the period of September 2016 to October 2018,to serve as the intensive group and control group.Blood glucose was controlled to 4.4~6.1mmol/L in the intensive group,while the control group's was controlled to 8~10mmol/L.The Insulin sensitivity index(ISI),homeostasis model assessment-insulin resistance index(HOMA-IR),and more Functional indicators of beta cells of the islet,Tumor necrosis factor-alpha(TNF-?),Interleukin-6(IL-6),c-reactive protein(CRP),interleukin-8(IL-8),and more Inflammatory factor levels,and T cell subsets of CD4~+,CD8~+,CD4~+/CD8~+for both two groups were studied at before treatment and after treatment for 7days.And the incidence of complications during treatment was compared between the two groups.Results:1.The experimental group had FPG,CPR,TNF-?,IL-6,IL-8,higher than the control group,the difference was statistically significant(P<0.01);2.In the experimental group,the immunological indicators of CD4+T lymphocytes and CD4+/CD8+were lower than those of the control group.The CD8+T lymphocytes in the experimental group were higher than the control group,the difference was statistically significant(P<0.01);3.In the experimental group,plasma CPR,TNF-?,IL-6,and IL-8,CD8+T lymphocytes in the high blood glucose group were higher than normal blood glucose group,the difference was statistically significant(P<0.05);CD4+T lymphocytes and CD4+/CD8+were lower than those in the normal blood glucose group,the difference was statistically significant(P<0.05);4.There was a positive correlation between FPG and CPR,TNF-?,IL-6,IL-10 and CD8+(P<0.05),which was negatively correlated with CD4+and CD4+/CD8+(P<0.05).5.Before treatment,there are no difference about HOMA-IR and ISI between two groups,While,after treatment for 7days,the intensive group had HOMA-IR lower than the control group,and ISI higher than the control group,the difference was statistically significant(P<0.05);6.Before treatment,there are no difference about inflammatory factors and immune function between two groups,While,after treatment for 7days,the intensive group had TNF-??IL-6?CRP?IL-8 lower than the control group,CD4+?CD4+/CD8+higher than the control group,and the CD8+level lower than the control group,the difference were statistically significant(P<0.05);7.During the treatment,the intensive group had infection rate(10.34%)lower than that(25.86%)of the control group,the difference was statistically significant(P<0.05).And there was no significant difference in other complications(p>0.05).Conclusions:1.Patients with severe burns will experience stress response,stress hyperglycemia,and inflammatory factors and immune functions in the body will be significantly changed.2.There was a significant correlation between blood glucose and inflammatory factors and immune level in patients with severe burns.The higher the blood glucose,the more obvious the inflammatory response and the lower the immune function.3.Intensive insulin control can effectively reduce SH in severely burned patients,correct insulin resistance,improve the body's sensitivity to insulin,inhibit the generation of inflammatory factors,restore the body's immune capacity,reduce the incidence of infection rate,and contribute to the recovery of severely burned patients,which is worthy of clinical recommendation.