危重症患儿应激性高血糖的监测及预后

The monitoring and prognosis on irritable hyperglycemia in critical diseased children

目的 探讨危重症患儿血糖水平与病情和预后之间的关系.方法 对106例危重症患儿入院后即采集静脉血,用葡萄糖氧化酶法测血糖并进行动态监测,空腹血糖≥6.9 mmol/L诊断为高血糖.结果 正常对照组、单器官及多器官功能衰竭患儿组的血糖分别为(4.8±1.3)、(8.3±3.1)、(14.2±6.6)mmol/L(P<0.01),血糖浓度与器官功能衰竭个数呈正相关(r=0.461,P<0.01);危重症患儿血糖、血K+较对照组显著升高(P<0.01),血Na+、血Ca2+较对照组显著降低(P<0.05),血糖浓度与血Na+、Ca2+浓度呈负相关(r=-0.343,r=-0.452;P<0.01),与血K+浓度呈正相关(r=0.574,P<0.01);血糖<15 mmol/L组病死率13.06%,≥15 mmol/L组病死率54.54%,血糖值越高,病死率越高.结论 危重患儿血糖浓度与病情危重程度呈正相关,血糖越高,病情越严重,预后越差.

Objective To investigate the relationship between levels of blood glucose and organ failure,prognosis in children with critical disease. Methods Venous blood glucose of 106 children with critical disease were analyzed with the method of glucose oxydase after admission and continuously monitored that.The index of hyperglycemia was value of fasting blood glucose ≥6.9 mmol/L. Results The level of glucose of the normal control group, haplo-organ failure group and multiple-organ failure group were (4.8±1.3),(8.3±3.1),(14.2±6.6) mmol/L, respectively (P<0.01).The quantity of organ failure was positive correlation with the level of blood glucose (r=0.461,P<0.01). The blood glucose,K+ of children with critical disease were significant increase as to normal control group(P<0.01), but blood Na+ and Ca2+ were lower in contrast. The level of glucose was positive correlation with the level of blood Na+,Ca2+ (r=-0.343,r=-0.452;P<0.01) and negative correlation with blood K+(r=0.574,P<0.01). The mortalities were 13.06% and 54.54% in corresponding blood glucose levels of less than 15 mmol/L and more than 15 mmol/L. The higher the blood glucose value, the higher the death rate. Conclusions The level of blood glucose in children with critical disease is closely associated with organ failure and prognosis,the higher the blood glucose value is, the pathogenetic condition is more severity, the prognosis is more imminent.