危重症患者不同原因血糖升高的临床意义及预后

Clinical significance and prognosis of the diverse causal hyperglycemia of critical patients

目的探讨急诊危重症患者不同原因导致的血糖升高以及与预后的关系。方法选择北京朝阳医院急诊抢救室2006年10月至2007年11月救治的危重症患者826例，就诊第1小时内进行快速随机血糖测定，有651例患者随机血糖异常升高并进一步行糖化血红蛋白（g｜ycatedhemoglo-bin，GHb）检测，根据GHb测试结果将651例患者分为GHb正常与GHb升高两组。651例患者均随访28d记录患者是否诊断为糖尿病（包括就诊时已经明确糖尿病）以及生存死亡情况，GHb正常与GHb升高两组患者根据患者是否确诊为糖尿病再分为两亚组，分别计算各个亚组患者28d病死率。结果651例随机血糖异常升高患者确诊糖尿病患者385例，其中既往无糖尿病病史者155例，占血糖升高例数的23．81％；应激性高血糖266例，占血糖升高例数的40．86％；GHb升高组患者28d病死率（12．23％）较GHb正常组患者28天病死率（5．82％）明显升高（P=0．001）；GHb升高组内无明确糖尿病病史患者病死率（19．21％）较有明确糖尿病病史患者病死率（7．11％）明显升高（P=0．000）。结论危重症患者既往无明确糖尿病史血糖升高不能全部归因为应激性高血糖；不同原因导致的危重症患者血糖升高其预后不同。

Objective To clarify the clinical significance and prognoses of critical patients with hyperglycemia incurred by various causes. Method A total of 826 critical patients were enrolled during the period from October 2006 to November 2007, and blood sugar was measured by using rapid testing devices within the first hour after admission. If blood sugar measured was more than 11.1 mmol/L, the diagnosis of hyperglycemia was made, and furthermore, glycosylated hemoglobin （GHb） was detected as well. The diag- nosis of hyperglycemia was made in 651 critical patients and those patients were followed up for 28 days to confirm the diagnosis. According to the levels of GHb, they were divided in two groups, namely normal GHb and high GHb groups. Each group was further divide into two subgroups, namely diabetes group and non diabetes group in order to compare the fatality rate between the two groups. Results There were 385 patients diagnosed to have diabetes and among them, 155 patients had no clear history of diabetes, accounting for about 23.81% of the 651 hyperglycemia patients. There were 266 （40.86%） patients were diagnosed to have stress induced hyperglycemia, The fatality rate of 28 -day in the high GHb group was higher than that in the normal GHb group （ 12.23% vs 5.82%, P =0.001 ） . In the high GHb group, the fatality rate of 28-day in the patients without clear history of diabetes was higher than that in the patients with clear history of diabetes （19.21% vs 7.11%, P = 0. 000）. Conclusions The hyperglycemia found in critical patients could not be all attributed to the stress induced hyperglycemia especially in the patients without clear history of diabetes, and the prognoses of patients with variously causal hyperglycemia were various.