内科重症监护病房住院患者高血糖临床资料分析——上海仁济医院2002至2009年资料回顾

Clinical analysis of inpatients with hyperglycemia in the medical intensive care units Data of Shanghai Renji Hospital from 2002 to 2009

目的调查并探讨内科重症监护病房（ICU）住院患者高血糖发生率及高血糖管理与病情、预后的关系。方法利用病案查询系统检索上海交通大学医学院附属仁济医院2002至2009年内科ICU住院患者病历，对所有资料进行回顾性分析。结果（1）共纳入2631例患者，2168例患者在住院期间测定血糖至少一次，高血糖发生率26．3％，其中既往有糖尿病病史者占12．9％，无糖尿病病史的高血糖患者占13．4％。既往有糖尿病病史合并高血糖的患者中，93．2％住院期间给予了降糖治疗，降糖方案以口服药物（53．0％）和皮下注射胰岛素（24．9％）为主；在既往无糖尿病病史的商m糖患者中，84．4％的患者住院期间没有给予任何降糖治疗；与既往有糖尿病病史合并的高血糖组相比，该组死亡率明显升高（30．4％对13．9％，P〈0．01）。（2）在既往有糖尿病病史组中，与组内血糖≤7．0mmol／L亚组相比，血糖〉10mmol／L亚组的死亡率升高（20．5％对9．9％，P〈0．05）；既往无糖尿病病史的高血糖患者，当血糖〉7．0mmol／L时，则死亡率就开始升高（P〈0．01）。（3）多元逐步回归分析显示平均血糖是死亡的独立危险因素（OR=1．26）。结论内科ICU住院患者高血糖发生率高，其血糖管理及治疗须引起重视；危重患者高血糖水平可能是死亡率增加的独立危险因素。

Objective To analyze the association of the morbidity, the management of blood glucose, and the prognosis of patients with hyperglycemia in the medical intensive care units （ICU）. Methods Medical records of ICU patients of Renji Hospital from 2002 to 2009 were reviewed using Medical Record Inquiry System, and the data were retrospectively analyzed. Results （ 1 ） 2 631 subjects were included in the present study, blood glucose was determined at least once during hospitalization in 2 168 of them. The incidence of hyperglycemia was 26.3% , in which 12.9% presented a known history of diabetes and 13.4% without. In the patients with diabetes history, 93.2%o of them received anti-diabetic treatment during hospitalization, mainly with oral anti-hyperglycemic agents （53.0%） or subcutaneous insulin injection （24.9%0）. However, in the patients without diabetes history, 84.4% were not treated against hyperglycemia. The mortality was increased in the latter group （30.4% vs 13.9% , P〈 0. 01 ）. （2） In the patients with diabetes history, the mortality in patients whose blood glucose 〉10 mmol/L was higher than those with blood glucose ≤7.0 mmol/L （20.5% vs 9.9% , P〈0.05 ） ; while in the patients without diabetes history, the mortality began to rise as blood glucose 〉 7.0 mmol/L （P〈0.01）. （3） Multiple stepwise regression analysis revealed that the average blood glucose level was an independent risk factor for death （ OR = 1.26 ）. Conclusions The ICU patients showed a high prevalence of hyperglycemia, the management of hyperglycemia should be emphasized. Hyperglycemia in critically ill patients might be an independent risk factor of increased mortality.