应激高血糖和内科重症监护病房患者预后关系的探讨

Impact of stress hyperglycemia on prognosis of patients in medical intensive care unit

目的探讨应激高血糖对内科重症监护病房（MICU）病人预后的影响。方法对入住武汉大学人民医院内科重症监护病房共1016例患者的资料进行回顾性分析。126例既往有糖尿病病史和890例无糖尿病病史的患者[按入院时血糖分为组1（〈6mmol／L），组2（6mmol／L^-1），组3（8～10mmol／L），组4（〉10mmol／L）]，观察住院病死率，次要观察指标包括住院时间、住ICU时间、是否予以机械通气、抗生素、输血和血糖的治疗。结果既往无糖尿病患者病死率分别为组1（4．7％）、组2（12．1％）、组3（20．5％）、组4（30．3％），随着血糖的升高，无糖尿病组患者病死率增加；机械通气、输血、抗生素治疗的比例增高；住ICU时间延长。结论高血糖在内科重症监护病房患者中十分常见，是增加内科ICU患者死亡和预示预后差的一个重要因素。

Objective To evaluate the association between stress hyperglycemia and clinical outcomes among patients with and without diabetes mellitus admitted to medical intensive care unit （MICU）. Methods We reviewed the medical ICU records of 1016 consecutive patients admitted to Wu Han University Ren Min Hospital. According to admission glucose level, 126 patients with debates and 890 patients without known debates were divided into group 1 （ 〈 6 mmol/L） , group 2 （6 - 8mmol/L） , group 3 （8 - 10mmo]/L） , and group 4 （ 〉 10mmo[/L）. The primary end point of the study was in-hospital mortality. Secondary end points included length of hospital stay, length of ICU stay, the ratio of mechanical ventilation, blood transfusions, antibiotics and blood glucose treatment. Results The hospital mortality among patients without a history of diabetes mellitus was 4.7% , 12. 1% , 20. 5% , 30. 3% in group 1, 2, 3, 4, respectively. The ratio of mechanical ventilation, blood transfusions, and antibiotics increased progressively as glucose values increased. Conclusions Hyperglycemia was a common disease, and it may be an important marker of poor clinical outcome and mortality in patients without history of diabetes.