危重症患者血糖动态水平监测及其对预后的影响

Effect of Dynamic Blood Glucose Levels on Prognosis of Critically Ⅲ Patients

目的探讨危重症患者血糖动态水平监测及其对患者预后的影响。方法收集綦江县人民医院急诊ICU收治的危重症患者160例,以入院时空腹血糖升高的程度进行分组:A组(血糖≤6.1 mmol/L)21例,B组(血糖6.1~10mmol/L)68例,C组(血糖≥10 mmol/L)71例。应用美国强生one TouchR ultraTM微机血糖仪及试纸对所有患者进行血糖动态监测。观察三组患者入ICU时急性生理和慢性健康状况评分(APACHE Ⅲ评分)、住ICU天数、多器官功能衰竭综合征(MODS)发生率及住院死亡情况。同时根据患者预后,将160例病例分为生存组112例和死亡组48例,收集所有患者入ICU 1、6、12、24、48、72 h时的血糖动态监测结果。结果三组APACHE Ⅲ评分、住ICU天数比较差异均有统计学意义(P均<0.01)。A组和B组MODS发生率均明显低于C组(P均<0.01),而A组MODS发生率略高于B组,但两组之间差异无统计学意义。A组和C组住院死亡率均明显高于B组(P均<0.01),而C组住院死亡率略高于A组,但两组之间差异无统计学意义。在入ICU 1、6、12、24、48、72 h每个时间点上,生存组的血糖水平呈持续下降,而死亡组血糖呈持续升高,明显高于生存组(P均<0.01)。结论血糖动态变化与危重症患者的预后密切相关,可作为危重症患者的重要临床监测指标。

Objective To explore the impact of dynamic blood glucose levels on the prognosis of critically ill patients.Methods One hundred and sixty ICU patients hospitalized in the People＇s Hospital of Qijiang County were divided into 3 groups according to their blood glucose levels： group A（n=21,≤6.1mmol/L）,group B（n=68,6.1 mmol/L^10 mmol/L）,and group C（n=71,≥10 mmol/L）.The dynamic blood glucose levels of all the patients were monitored by one TouchR ultraTM microcomputer glucose instrument and urine glucose reagent strips.APACHE III scores,the hospitalization days in ICU,the incidence rate of MODS and mortality were observed.At the same time,according to the prognosis,160 patients were divided into survival group（n=112） and non-survival group（n=48）.The blood glucose levels of all the patients hospitalized in ICU were recorded at 1,6,12,24,48 and 72 hrs,respectively.Results There were statistically significant differences in APACHE Ⅲ scores and the hospitalization days in ICU among the three groups（P0.01）.The incidence rates of MODS in group A and group B were significantly lower than that in group C（P0.01）.No statistically significant difference was found in the incidence rates of MODS between group A and group B.The mortalities in group A and group C were significantly higher than that in group B（P0.01）.No statistically significant difference was found in the mortalities between group A and group C.In the survival group,the levels of blood glucose decreased continuously at 1,6,12,24,48 and 72 hrs after entering ICU,which were significantly lower than those in non-survival group（P0.01）.Conclusions There is a close relationship between the dynamic changes of blood glucose levels and the prognosis of patients.The dynamic changes of blood glucose levels may be a good marker to evaluate the prognosis of critically ill patients.