脓毒症患者ICU治疗期间血糖与预后的相关性分析研究

The study about correlation between blood glucose and prognostic of patients with sepsis in ICU

目的:探讨应用胰岛素控制血糖与脓毒症患者预后的相关性。方法:回顾研究我院重症监护病房(ICU)2002年5月1日～2005年4月30日脓毒症患者128例,按照在胰岛素控制下血糖的水平将其分为4组,血糖4.0～5.9 mmol/L组,6.0～7.9 mmol/L组,8.0～12.4 mmol/L组,>12.5 mmol/L组,回顾性调查各组的病情严重程度(APACHEⅡ评分)、多脏器功能障碍综合征(MODS)发生率及病死率等资料,在4组之间进行比较。结果:应用胰岛素将血糖控制在4.0～5.9 mmol/L组,MODS发生率及病死率均显著低于其他3组(P<0.05);并且血糖水平与患者病死率、MODS发生率、ICU住院天数、抗生素使用时间及机械通气时间存在正相关关系。结论:应用胰岛素控制血糖与脓毒症患者预后密切相关,严格控制血糖在4.0～5.9 mmol/L显著降低患者的病死率,改善预后。血糖水平控制不理想,会相应增加患者病死率、MODS发生率,延长患者ICU住院天数、抗生素使用时间及机械通气时间。

Objective： We investigate the correlation between control of blood glucose with insulin and prognosis of of patients with sepsis. Methods： We analyzed retrospectively 128 patients with sepsis in intensive care unit （ICU） of our hospital from May 1st, 2002 to Apr 30th,2005. They were divided the patients into four groups acording to the blood glucose level controlled by insulin, blood glucos 4.0-5.9 mmol/L,6.0-7.9 mmol/L,8.0-12.4 mmol/L, and 〉12.5 mmol/L.We analyzed disease Severity （APACHE I1 score） , incidence of multiorgan dysfunction syndrome （MODS） and mortality of the patients. They were compared with each other of these four groups. Results： The incidence of MODS and mortality in blood glucose 4.0-5.9 mmol/L group were all significantly lower than the other three groups （P〈0.05）;and blood glucose level was positive correlated with mortality, incidence of MODS,duration of intensive care, days of ventilatory support and treatment with antibiotics. Conclusion： The prognosis of the patients with sepsis is correalated with blood glucose controlled by the insulin. It can significantly lower the mortality and improve the prognosis of the patients with sepsis that blood glucose is strickly controlled between 4.0 to 5.9 mmol/L .If blood glucose isn＇t controlled well, mortality, incidence of MODS,duration of intensive care unit,days of ventilatory support and days of treatment with antibiotics will increase accordingly.