重症患者基础血糖浓度与病情程度相关性研究及生存分析

Correlation between baseline blood glucose and disease severity:a survival analysis in critical cases

目的研究重症患者早期基础血糖浓度分布与病情程度间相关性,进行生存分析。方法根据2009年1—6月入科监测的基础血糖值,将207例重症患者分成3组:A组,血糖<4.5 mmol/L;B组,血糖4.5～8.3 mmol/L;C组,血糖>8.3 mmol/L。统计分析各组患者危重程度及预后指标。结果 (1)A组患者的APACHEⅡ评分(22.54±13.46)显著高于B组(10.30±6.23)和C组患者(14.74±8.49),差异有统计学意义(P<0.05);(2)A组患者MODS发生率、感染发生率、血管活性药物使用率分别为75.0%、62.5%、50.0%,与B、C组患者比较有明显差异(P<0.05);(3)A组患者基础血糖浓度与APACHEⅡ、MODS和SOFA评分均存在显著相关性,C组患者仅与APACHEⅡ评分存在相关(P<0.01);(4)生存分析显示A组患者较B、C组患者比较,28 d生存值明显降低,存活率仅54.2%(P<0.01)。结论早期基础血糖的监测与评估可以作为对重症患者病情和预后判断的一项重要指标。血糖浓度低于4.5 mmol/L时,应尽早进行干预治疗及器官功能保护。

Objective To study the relationship between distribution of early baseline blood glucose（BG） and disease severity,and to perform a survival analysis in critical cases.Methods According to their baseline blood glucose during January and June of 2009,207 critical patients were divided into Group A（BG4.5 mmol/L）,Group B（BG：4.5～8.3 mmol/L） and Group C（BG8.3 mmol/L）.Statistical analysis on severity and prognosis was conducted for each group.Results（1）The APACHE Ⅱ scores of Group A（22.54±13.46） were significantly higher than those of Group B（10.30±6.23） and Group C（14.74±8.49）,with statistical significance noted（P〈0.05）;（2）The incidence of MODS,infections and use of vasoactive agents in Group A were 75%,62.5% and 50% respectively,which were significantly different from those in Groups B and C（P〈0.05）;（3）Baseline blood glucose was significantly correlated with scores of APACHE Ⅱ,MODS and SOFA in Group A but only correlated with APACHE Ⅱ scores in Group C（P〈0.01）;（4）According to survival analysis,28 d survival rate in Group A（54.2%） was significantly lower than in Groups B and C（P〈0.01）.Conclusion Monitoring and evaluation of early baseline blood glucose may be an important approach to evaluation of severity and prognosis in critical cases.At a blood glucose level less than 4.5 mmol/L,early intervention and organ function protection should be initiated as quickly as possible.