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目的提出糖代谢障碍相关指标作为创伤MODS(多器官功能不全综合征)改良诊断标准和极化液个体化临床干预治疗技术方案,降低创伤患者住院病死率。方法将胰岛素分泌指数、胰岛素抵抗指数、血糖和乳酸作为诊断创伤MODS指标,制订创伤MODS诊断标准和创伤患者极化液个体化临床干预理论和经验指导公式,并随机应用于本院创伤外科病区重症监视室(ICU)医疗工作中。通过回顾性调查2001年1月至2004年1月本院2247份病历,统计创伤MODS改良诊断标准和常规诊断标准MODS诊断率变化,以及极化液组(1196例)及其基础对照组(1051例)ICU创伤MODS发生率,MODS死亡率的变化。结果(1)创伤ICU患者改良标准MODS诊断率为12.37%(278/2247),明显高于常规标准诊断率9.84%(221/2247),P<0.05。(2)参照创伤MODS改良诊断标准,极化液组MODS发生率和MODS病死率分别为10.95%(131/1196)和63.36%(83/131),明显低于基础对照组13.99%(147/1051)和74.83%(110/147),P分别<0.01和0.05。结论糖代谢障碍相关指标作为创伤MODS改良诊断标准,可提高创伤MODS诊断率,减少MODS漏诊率,为临床及时干预创伤MODS,具有重要意义。极化液对创伤MODS有辅助治疗和预防作用,值得临床推广。
OBJECTIVE: To propose an improved diagnostic criteria for traumatic MODS (multiple organ dysfunction syndrome) and a personalized clinical intervention therapy protocol for reducing the inpatient mortality of patients with trauma due to the indicators related to glucose metabolism disorders. Methods Insulin secretion index, insulin resistance index, blood glucose and lactate were used as indicators of MODS in diagnosis of trauma. The clinical diagnostic criteria of individual traumatic patients with MODS of trauma and traumatic patients were established. The theory and empirical guidance formula were used and randomly assigned to the traumatic surgery ward Intensive Care Unit (ICU) medical work. By retrospectively investigating 2247 medical records in our hospital from January 2001 to January 2004, the diagnostic criteria of MODS of traumatic MODS and routine diagnostic criteria were statistically analyzed, and the changes of MODS in the polar fluid group (1196 cases) and its basic control group (1051 Cases) ICU traumatic MODS incidence, MODS mortality changes. Results (1) The diagnostic rate of MODS in patients with traumatic ICU was 12.37% (278/2247), significantly higher than that of routine diagnostic criteria (221.2247, 9.84%, P <0.05). (2) According to the modified diagnostic criteria of traumatic MODS, the morbidity of MODS and MODS in the polar fluid group were 10.95% (131/1196) and 63.36% (83/131), respectively, which was significantly lower than that of the baseline control group (13.99% 1051) and 74.83% (110/147), P <0.01 and 0.05, respectively. Conclusion The index of glucose metabolism disorders as an improved diagnostic criteria for traumatic MODS can improve the diagnostic rate of traumatic MODS and reduce the rate of misdiagnosis of MODS, which is of great significance for timely and timely intervention of traumatic MODS. Polarized fluid on the traumatic MODS have adjuvant treatment and prevention, worthy of clinical promotion.