The Effect Assessment Of Low Doses Insulin Treatment Of Sepsis In Children With Hyperglycemia

Objective: Sepsis is one of common diseases in pediatrics, critically ill children trend tosuffer multiple organ damage that will increase children’s risk of death. Hyperglycemia isan important symbol of metabolic disorder after onset of sepsis. To control hyperglycemiaof sepsis in children can help to reduce their complications and mortality. This study hasprospectively to blood glucose monitoring and programmed blood glucose management inpediatric intensive care unit (PICU), evaluation of the therapeutic effect of low dosesinsulin to treatment of hyperglycemia of sepsis in children, and systematic analysis thenecessity of low doses insulin to treat sepsis in children with hyperglycemia, and clear theimportance of early management of hyperglycemia.Methods:462sepsis, severe sepsis and septic shock of critically ill children admitted inPICU of Hunan Children’s Hospital from June1,2012to October31,2013. All thechildren were given the PCIS scores within24h after admission, excluded the childrenadmitted to hospital PICU<3days or within3days of death, hospitalized children havereduce glucose tolerance (IGT) or diagnosis of diabetes, lead to blood glucose metabolismdisorder of endocrine disease, accepted or quasi adrenal cortical within2months, usingimmune inhibitors, or suffering from children with tumor, insulin allergy. In accordancewith the contemplated the clinical registration form to collect information to take theprospective observational and analysis, in different periods of blood glucose, blood routine,c-reactive protein(CRP), procalcitonin (PCT)，liver function, renal function, myocardialenzyme, blood coagulation function, insulin(INS) and c-peptide(C-P) and other relatedinfections and biochemical indicators were measured and recorded. On blood glucosevalue<11.1mmol/L with the methods of limit glucose infusion intervention, and bloodglucose>11.1mmol/L that using low doses of insulin treatment, prospective blood glucosemanagement system procedures.Results:1. The incidence of sepsis in children with hyperglycemia was49.78%. Using low doses insulin treatment measures for the management of blood glucose, sepsis, severe sepsis andseptic shock in the group of hyperglycemia children can achieve good hypoglycemiceffect, sepsis in children with hyperglycemia has fallen to (5.97±1.49)mmol/L within24hours in hospital, children with severe sepsis and septic shock has fallen to (6.45±3.44)mmol/L.2. The treatment group with low doses insulin treatment lead to blood glucose had declinesignificantly, and on day1, day3, day7after admission were statistically differencebetween three groups the mean blood glucose (H1=259.752, P1=259.752; H3=24.603,P3=0.000; H7=13.462, P7=0.001).Severe sepsis and septic shock patients admitted tohospital after treatment the blood sugar monitoring statistically difference between threegroups(H1=31.974, P1=31.974; H3=38.592, P3=0.000; H7=29.277, P7=0.001).3. The infection indexes of children appeared a downward trend in the period of low dosesinsulin treatment. Of sepsis in children with low doses insulin group the WBC levelsignificantly lower than the limit glucose group on day3and7, with statistical significance(P3<0.05, P7<0.05). PCT level significantly lower than the limit glucose group of sepsischildren on day3,day7, with statistical significance (P3<0.01, P7<0.05).Compared withlimit glucose group, treatment group CRP were higher than the limit glucose group in eachday. Severe sepsis and septic shock in children with low doses insulin the WBC levelbelow the limit of sugar group on day3, day7,with statistical significance (P3<0.05, P7<0.05). PCT of treatment group below the limit glucose group on day3, with statisticalsignificance (P<0.05). CRP value compared between two groups were no statisticaldifference on day3,day7(P>0.05).4. The treatment group of children with severe sepsis and septic shock that ALT value werelower than limit glucose group, with statistical difference (P<0.01) on day3. CK-MBvalue in the treatment group compared with the limit glucose group were statisticalsignificance (P<0.05).Conclusion:1. Low doses insulin in the treatment of sepsis in children with hyperglycemia couldreduce blood glucose level with safe and effective, as well as not easy to bad conditionssuch as hypoglycemia. 2. Low doses insulin in the treatment of sepsis children could reduce the levels ofWBC,PCT early, suggesting us that use low doses insulin have improved inflammationindexes of sepsis children, inhibit the action of the children with inflammatory response.3. Low doses insulin in the treatment could reduce the levels of ALT, CK-MB early,suggesting that reduce sepsis in children with organ damage degree, to help childrenimprove their prognosis.