耐糖能障害を伴う敗血症患者におけるインスリンクリアランス測定法およびインスリンクリアランスへ影響する要因の検討 : ベッドサイド型人工膵臓による厳密な血糖管理下での分析 Measurement of insulin clearance and factors affecting insulin clearance in septic patients with glucose intolerance : analysis under strict blood glucose control by means of bedside-type artificial pancreas
Seven non-septic and twenty-two septic ICU patients with glucose intolerance were investigated by using bedside-type artificial pancreas (AP). IC was measured by the glucose clamp method (GC) in which BG level was clamped at 80mg/dL with two step insulin infusion rate (IIR) of 1.12 and 3.36mU/kg/min. Results: 1) IC could be estimated by the following formula: IC (mL/kg/min) =⊿IIR/⊿I≒2240/(I3-I1), (⊿IIR (mU/kg/min): difference of the amount of exogenous insulin infusion, ⊿I (mU/L): difference of the blood concentration of exogenous insulin, I1 (I3): blood concentration of insulin when IIR is 1.12 (3.36) mU/kg/min), because the difference between blood concentration of endogenous insulin when IIR was 1.12 mU/kg/min and that when IIR was 3.36mU/kg/min was small enough to be neglected. 2) IC was increased in 11 septic patients (50%) and was within normal limits in 8 septic patients (36%). 3) Among the factors which have been reported to influence IC in chronic diseases (age, body mass index, hyperlipidemia, blood lactate level, thyroid hormone, growth hormone, cortisol, organ dysfunction and its related parameters, etc.), only cardiac index was positively correlated with IC (y=3.3x+4.0, n=22, r=0.63, P<0.002).Conclusions: Measurement of IC on critical patients was established with our modified GC with two step insulin infusion. Hyperdynamic state was considered to be closely related to the increased IC.
千葉医学雑誌 82(3), 149-161, 2006-06-01