多发伤患者血糖水平及血糖变异性与预后的相关性分析

The correlation analysis between glucose level and its variability and prognosis in traumatic patients

目的探讨血糖水平和血糖波动对多发伤患者预后的影响。方法回顾性分析300例多发伤患者人住重症监护病房（ICU）72h内平均血糖（GluAve）、血糖标准差（GluSD）、血糖变异率（GluCV）。根据预后将患者分为存活组（249例）及死亡组（51例），比较两组间GluAve、GluSD、GluCV。将GluAve分为5个亚组（3．9～5．5、5．6-6．6、6．7-7．7、7．8-9．9、≥10．0mmol／L）、GluCV分为4个亚组（〈15％、15％-30％、30％-50％、〉50％），分别分析不同亚组间院内病死率，并分析不同GluAve水平、GluCV亚组的病死率。采用多因素]ogistic回归分析多发伤患者死亡危险因素。结果死亡组cluAve（mm01／L）、GluSD（mmol／L）、GluCV均高于存活组[11．31＋4．38比8．50＋3．40，2．85＋1．94比1．87±1．67，（28．30±23．08）％比（20．90±13．70）％，均P〈0．05]。随GluAve、GluCV逐渐上升，病死率也逐渐升高（χ2=26．332、P=0．000，χ_2^2=65．522、P=0．000）。在GluAve7．8-9．9mmol／L亚组中，GluCV〈15％亚组及GluCV〉50％亚组的病死率分别为9．09％（3／33）与46．15％（6／13，P〈0．01），而GluAve≥10．0mm01]L亚组内相应病死率分别为21．05％（4／19）和61．54％（8／13，P〈0．05）。多因素logistie回归分析中，GluAve、GluCV为死亡危险因素[GluAve优势比（OR）=1．150，95％可信区间（95％CI）为（1．042，1．270），P=0．006；GluCVOR=1．022，95％C1为（0．999，1．040），P=0．040]，而GluSD对死亡无影响。结论GluAve、GluCV升高与多发伤死亡显著相关，控制血糖及血糖波动可能是减少多发伤死亡的重要策略之一。

Objective To investigate the effect of glucose level, variability on the prognosis of traumatic patients. Methods A retrospective study involving 300 traumatic patients admitted to intensive care unit （ICU） was performed. The average glucose （GluAve）, glucose standard deviation （GIuSD） and glucose coefficient of variation （GIuCV） during the first 72 hours were calculated. Patients were divided into survivor group （n =249） and non-survivor group （n =51） based on outcomes. The GluAve, GluSD and GluCV were compared between the two groups. Patients were allocated into five subgroups based on GluAve （3.9-5.5, 5.6-6.6, 6.7-7.7, 7.8-9.9, 1〉 10.0 mmol/L） as well as four subgroups on GluCV （ 〈 15%, 15%-30%, 30%-50%, 〉50%）. The mortality in hospital was compared among the different subgroups and the different GluCV in the same level of GluAve subgroups, respectively. Multifactor logistic regression was used to determine the risk factor of hospital death. Results The levels of GluAve （ mrnol/L ）, GIuSD （retool/L）, GluCV of non-survivor group were higher than those of survivor group [11.31 ± 4.38 vs. 8.50 ±3.40, 2.85 ± 1.94 vs. 1.87 ± 1.67, （28.30 ±23.08）% vs. （20.90 ± 13.70）%, all P〈0.053. With the gradual inereasement of GluAve and GluCV level, the mortality was raised accordingly （χ_2= 26.332, P= 0.000; χ_2^2= 65.522, P=0.000）. In the subgroup of GluAve 7.8-9.9 mmol/L, the mortality was 9.09% （3/33） with GluCV 〈 15% versus 46.15% （6/13） with GluCV 〉50% （P〈0.01） respectively, and in the subgroup of GluAve≥ 10.0 mmol/L, the mortality corresponding rates were 21.05% （4/19） with GluCV 〈 15% and 61.54% （8/13） with GIuCV 〉 50% （P〈 0.05 ）. The multivariable logistic regression analysis demonstrated that GluAve and GluCV were risk factors of mortality [GluAve odds ratio （OR）=-1.150, 95% confidence interval （95%CI） was 1.042 to 1.270, P=0.006; GluCV OR= 1.022, 95% CI was 0.999 to 1.040, P=0.040], GluSD had no effect on mortality. Conclusions The increase in GluAve and GluCV in traumatic patients are significantly correlated with mortality. Control the level and the variability of blood glucose might be an important aspect of the multiple trauma death reduction.