重症患者低血糖危险因素分析及与预后相关性研究

Research on risk factors of hypoglycemia in critical illness and correlation with prognosis

目的研究重症患者早期低血糖危险因素，分析低血糖水平与危重病程度及预后的相关性。方法根据入科监测的基础血糖值，将207例重症患者分成三组：A组血糖〈4．5mmol／L；B组血糖4．5～8．3mmol／L；C组血糖〉8．3mmol／L。统计分析各组患者危重程度及预后指标。结果，①A组患者内科疾患构成、肝功能及肾功能不全发生率分别为50．0％、41．7％、50．0％，显著高于B、C组患者（P〈0．01）；②A组患者APACHEH评分、乳酸、尿素氮、肌酐、总胆红素、谷丙转氨酶显著高于B、C组患者（P〈0．05）；③A组患者MODS发生率、感染发生率、血管活性药物使用率、28d生存率分别为75．0％、62．5％、50．O％、54．2％，与B、C组患者比较差异有统计学意义（P〈0．01）；④A组患者基础血糖水平与APACHE Ⅱ、GCS、MODS和SOFA评分均存在显著相关性（P〈0．01）；⑤对影响血糖的危险因素进行多元有序Logistic回归，结果显示总胆红素、谷丙转氨酶指标进入回归方程（P〈0．05）。结论血糖浓度〈4．5mmol／L时可作为对患者病情及预后判断的重要指标；重症患者早期低血糖的发生与患者肝、肾功能不全关系密切。

Objective To investigate the risk factors of early hypoglycemia in critical illness and to analyze the relationship between hypoglycemia and critical illness level, prognosis. Methods The early blood glucose of 207 critical patients was tested within 2 hours after admission. According to blood glucose level （BGL） of early stress period, they were divided into three groups： group A, BGL 〈 4.5 mmol/L; group B, BGL 4.5 - 8.3 mmol/L; group C, BGL 〉 8.3 mmol/L. To evaluate their scores of APACHE Ⅱ, GCS, MODS, SOFA and infection rate, vasoactive drug utilization, prognosis and biochemical indicator. Results ①The incidence rates of internal medicine, hepatic inadequacy and renal inadequacy in group A were 50.0%, 41.7%, 50.0% respectively, which were significantly different from group B and group C （ P 〈 0. 01 ） ; ②The APACHE Ⅱ score and biochemical indicator （ lactic acid, urea nitrogen, creatinine, total bilirubin, glutamic - pyruvic transaminase） of group A were statistically higher than those of group B and group C （P 〈 0.05 ） ;③The incidence rates of MODS, infection, vasoactive drug utilization and 28 - day survival rate in group A were 75.0%, 62. 5%, 50.0%, 54.2% respectively, which were significantly different from group B and group C（ P 〈 0.01 ） ; ④BGL in group A was correlated with scores of APACHE Ⅱ , GCS, MODS and SOFA （ P 〈 O. 01 ） ; ⑤Total bilirubin and glutamic- pyruvic transaminase indicators were included into the regression equation according to Multiple Logistic Regression on risk factors that influenced BGL （ P 〈 0.05 ）. Conclusion When the blood glucose level 〈 4.5 mmol/L, it can reveal severe degree of critical illness and worse prognosis. Early hypoglycemia in critical illness was closely related to the occurrence of liver and kidney dysfunction.