临床时讯 ＞ 临床研究
美国学者的一项随机对照临床试验表明，强化胰岛素治疗可降低严重烧伤患儿的死亡率。该研究发表于《美国呼吸与重症医学杂志》（American Journal of Respiratory and Critical Care Medicine）。
Am J Respir Crit Care Med. 2010 Aug 1;182(3):351-9.
Intensive insulin therapy in severely burned pediatric patients: a prospective randomized trial.
Jeschke MG, Kulp GA, Kraft R, Finnerty CC, Mlcak R, Lee JO, Herndon DN.
Shriners Hospitals for Children, Galveston, TX 77550, USA.
RATIONALE: 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.
OBJECTIVES: To determine whether intensive insulin therapy is associated with improved post-burn morbidity.
METHODS: 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).
MEASUREMENTS AND MAIN RESULTS: 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).
CONCLUSIONS: In this prospective randomized clinical trial, we showed that intensive insulin therapy improves post-burn morbidity. Clinical trial registered with www.clinicaltrials.gov (NCT00673309).