中文摘要：

目的：采用强化胰岛素治疗对脓毒血症患者应激性高血糖进行早期干预并观察临床效果。方法：以78例脓毒血症患者为研究对象,随机分为常规治疗组（CG组,n=38例）和强化胰岛素治疗组（IIG组,n=40例）,采用经静脉微量泵连续输注胰岛素的方式控制两组患者血糖水平,CG组餐前血糖水平控制在10.0-11.1mmol/L范围内,IIG组餐前血糖水平控制在4.4-6.1mmol/L范围内。采用酶联免疫吸附法检测两组患者治疗第0、3、6、9及12天时血清钙卫蛋白（SC）、肿瘤坏死因子（TNF）-α、白细胞介素（IL）-6的表达水平,并比较两组患者机械通气、抗生素使用及ICU住院时间、低血糖发生率、急性肾衰竭及死亡率等临床指标。结果：IIG组在机械通气时间、抗生素使用时间、ICU住院时间、急性肾衰竭（ARF）发生率及死亡率均较CG组显著下降（P〈0.05）,其中急性肾衰竭（ARF）发生率与患者的死亡率显著相关（r=0.945,P〈0.05）;与常规治疗组比较,治疗第6、9及12天血清SC表达水平均显著下降（P〈0.05）;发生ARF的患者,在治疗各时段血清SC水平均显著高于非ARF的患者（P〈0.05）;两组患者TNF-α、IL-6水平都呈现明显下降趋势,组内各时间点比较,治疗第3、6、9、12天均较治疗第0天的水平显著下降（P〈0.05）。结论：强化胰岛素治疗脓毒血症有显著疗效,可降低血清SC、TNF-α及IL-6表达水平,降低患者死亡率,血清SC水平可能是一个独立的影响脓毒血症预后的因素。

英文摘要：

Objective：To observe the effect of the early intervention for septic patients with the stress hyperglycemia. Methods： 78 patients with sepsis were randomly divided into two groups： inten- sive insulin therapy group （IIG, n=40） and conventional therapy group （CG, n=38）. Insulin was injected through peripheral vein with micro syringe pump continuously to control blood sugar for all patients; the preprandia blood sugar level of CG group was controlled within 10.0-11. 1 mmol/L while the preprandia blood sugar level of IIG group was controlled from 4.4-6.1 rnmol/ L. Then the expression of serum calprotectin （SC）, TNF-α and IL-6 in serum were measured by ELISA 0, 3, 6, 9, and 12 days after treatment. Furthermore, the mechanical ventilation time, the time of using antibiotics, ICU length of hospital stay, the incidence of hypoglycemia, the rate of acute renal failure（ARF） and mortality and other clinical indicators were compared between the two groups. Results.. The mechanical ventilation time, the time of using anti-biotics, ICU length of hospital stay, ARF rate and mortality in IIG group were significantly lower than those in CG group （P〈0.05） ; and the incidence of ARF was significantly correlated with the mortality of the patients （r=0. 945, P〈0.05）; compared with CG group, the expression of SC on the 6th,9 th, 12 th day after treatment were significantly decreased in IIG group （P〈0.05） ; during different time after treatment, SC expression of the patients with ARF was significantly higher than that of the patients without ARF （P〈0.05） ; TNF-α and IL-6 expression were significantly decreased in both groups, and were gradually decreased on the 3rd, 6th, 9th, 12th day than that at the be- ginning of treatment （P〈0.05）. Conclusion： Intensive insulin has evident efficacy On sepsis, it could reduce the expression of SC, TNF-α and IL-6, and also could reduce mortality. Further- more, SC could be an independent prognostic factor for sepsis.