非糖尿病危重症患者的血糖波动对病死率的影响

Influence of fluctuation of blood glucose to the mortality of non - diabetic critically ill patients

目的探讨非糖尿病危重症患者的血糖波动对病死率的影响。方法采用前瞻、随机的临床研究方法，以239例非糖尿病危重症患者为研究对象，以血糖标准差评估血糖波动程度，根据血糖标准差将所有患者分为两组：高波动组（血糖标准差≥血糖平均值）与低波动组（血糖标准差〈血糖平均值），统计所有患者的病死率，分析血糖波动对病死率的影响。结果在排除肠内营养及激素用量影响的前提下，血糖波动性较小的危重症患者病死率明显降低（4．O％vs13．0％，P〈0．05），存活患者的ICU住院时间明显缩短[（5．9±2．0）dV8（15．2±7．7）d，P〈0．05]。与血糖波动性相比，不同的绝对血糖值对危重症患者病死率（6．2％V87．3％，P〉0．05）及ICU住院时间[（9．3±3．0）dVS（11．3±5．9）d，P〉0．05]的影响差异均无统计学意义。结论血糖波动性低的危重症患者病死率较低。

Objective To investigate the influence of blood glucose fluctuation on the mortality of non- diabetic critically ill patients. Methods We design a prospective, randomized clinical trial, with 239 cases of non - diabetic critically ill patients as study objects. The blood glucose fluctuation was evaluated with standard deviation of blood glucose. The patients were divided into two groups according to the standard deviation： the higher fluctuation group （ standard deviation t〉 mean glucose） and the lower fluctuation group （standard deviation 〈 mean glucose）. The relationship between the blood glucose fluctuation and the patients＇ mortality were analyzed. Results The group with lower glucose fluctuation has a lower mortality（4.0% vs 13.0%, P 〈0.05） and shorter ICU stay[ （5.9 ± 2.0） d vs （ 15.2 ± 7. 7） d, P 〈 0.05 ] when compared with the higher fluctuation group, after excluding the confounding factors such as the enteral nutrition and the use of steroids. On the contrary, the different blood glucose values have no significant influences on the mortality （ 6.2% vs 7.3%, P 〉 0.05 ） and the ICU stay [ （9.3 ± 3.0） d vs （ 11.3 ± 5.9） d, P 〉 0.05 ] of critically ill patients. Conclusion The critically ill patients with lower blood glucose fluctuation has a lower mortality.