老年患者住院期间发生严重高血糖情况分析

Incidence of severe hyperglycemia during hospitalization in elderly patients

目的研究住院期间大于60岁的老年人群发生严重高血糖的情况及预后。方法通过计算机检索收集2010年1月1日至2011年12月31日在解放军总医院住院德大于60岁老年患者发生空腹或随机静脉血糖≥20．0mmol／L病例，分析发生此严重高血糖的原因、处置情况及预后。结果两年间共检出住院期间发生的严重高血糖100例（130例次）。其中糖尿病患者69例（90例次，占69．2％），非糖尿病患者31例（40例次，占30．8％），91％的患者住在非内分泌专科。导致高血糖的主要诱因有合并感染和急性病症。发生严重高血糖后3个月内死亡率54．0％（54例），糖尿病组（35例，64．8％）和非糖尿病组（19例，61．2％）死亡率相似（P〉0．05），多器官功能衰竭是主要死亡原因。27例患者并发高渗状态，死亡19例（70．4％），显著高于未并发高渗状态患者死亡率（47．9％，P〈0．05）。发生严重高血糖后1天纠正高血糖较2天以上纠正高血糖死亡率明显降低（39．1％VS80．6％，P〈0．01）。治疗后血糖仍≥16．7mmol／L死亡率为100．0％。结论并发高渗状态和多器官衰竭明显增加死亡率。发生严重高血糖后治疗及时（1天）、控制血糖〈16．7mmol／L有助于降低死亡率。

Objective To investigate the features and prognosis of the elderly individuals with severe hyperglycemia during hospitalization. Methads All hospitalized patients with age over 60 or older whose fasting or random blood glucose was greater than 20.0mmol/L in our hospital from Jan 1, 2010 to Dec 31, 2011 were enrolled in this study. The causes, medical management and prognosis of these patients were analyzed. Results The cohort of subjects included 100 participants, including 69 diabetic patients and 31 non-diabetic patients, and had 130 times of hyperglycemia, with 90 times for diabetic patients （69.2%） and 40 times for non-diabetic patients （30.8%）. And 91% of them were not hospitalized in the Department of Endocrinology. Infection and acute diseases were the main causes of hyperglycemia. The mortality of patients who died within 3 months following hyperglycemia was 54.0% （64.8% vs 61.2% between diabetic group and non-diabetic group, P 〉 0.05）. The main cause of death was multiple organ dysfuction. There were 27 patients having hyperosmolar state, and the mortality in patients with hyperosmolar state was significantly higher than in patients without hyperosmolar state （70.4% vs 47.9%, P〈 0.05）. Compared with patients whose glycemic was controlled in more than 2 d, the mortality of patients whose blood glucose were successfully controlled within 1 d was significantly lower （39.1% vs 80.6%, P 〈 0.01）. After treatment, the mortality of patients whose blood glucose remained ≥ 16.7mmol/L was 100.0%. Conclusion Hyperosmolar state and multiple organ dysfunction significantly increase the mortality. Timely reduction of blood glucose （within 1d） and the level of blood glucose less than 16.7mmol/L help to decrease the mortality.