中文摘要：

目的探讨早期胰岛素强化治疗对严重创伤患者凝血状态变化的影响。方法选择138例严重创伤患者（ISS〉20分）,随机分为胰岛素强化治疗组和对照组,分别给予胰岛素强化治疗和常规治疗,记录每天胰岛素用量和血糖值,分别检测血小板数（PLT）、D二聚体（DD）、蛋白C（PC）、蛋白S（PS）、抗凝血酶-Ⅲ（AT-Ⅲ）、血栓调节蛋白（TM）、组织纤溶酶原激活物（TPA）、纤溶酶原激活物抑制物-1（PAI-1）、凝血酶原时间（PT）、凝血酶时间（TT）、活化部分凝血活酶时间（APTT）、纤维蛋白原（FBG）等12项涉及到与凝血功能有关的实验室指标。结果强化治疗组每日平均胰岛素用量显著高于常规治疗组（P〈0.01）,平均血糖值显著低于常规治疗组（P〈0.05）。强化治疗严格控制血糖后,强化治疗组APTT、PT、TT较常规治疗组缩短,FBG升高（P〈0.05）,血小板高;TM低于常规治疗组（P〈0.05）,PC和PS则高于常规治疗组（P〈0.05）,AT-Ⅲ降低;PAI-1和DD低于常规治疗组,TPA则高于常规治疗组（P〈005）。结论胰岛素强化治疗能有效降低ICU中危重患者凝血系统功能紊乱。

英文摘要：

Objective To study the influence of early intensive insulin treatment on the changes of coagulation state of severe trauma patients. Methods 138 severe trauma patients （ ISS 〉 20） were randomly divided into intensive insulin treatment and control group, which were administered intensive and routine insulin respectively. The amount of insulin and blood glucose were noted every day, and PLT,DD, PC,PS,AT -Ⅲ, TM,TPA, PAI1 ,PT,TT,APTT and FBC were detected respectively. Results Average doses of insulin within a day in intensive insulin treatment were significantly higher than those in routine treatment group, but average blood glucose of intensive insulin treatment was lower than that of routine tre- ment group. After controlled strictly blood glucose with intensive insulin treatment, AFTT, PT and TT of intensive insulin treatment group shortened, but FBG rose（ P 〈 0. 05 ） , PLT was higher. TM ,PAI- 1 and DD were lower （ P 〈 0. 05 ） ; PC, PS and TPA were higher in comparison with routine treatment group （ P 〈 0.051. Conclusion Intensive insulin treatment can reduce the dysfunction of coagulation system in severe patients effectively.