危重症患者应激性高血糖及其控制水平与预后的关系

Association of stress hyperglycemia and its control level with the prognosis of critically ill patients

目的：探讨危重症患者应激性高血糖及其不同的控制水平与预后的关系。方法：选取发生应激性高血糖的危重症患者710例作为研究对象。根据患者的预后分为存活组和死亡组,对2组入院初始血糖、急性生理功能和慢性健康状况评分系统Ⅱ评分进行比较。根据患者血糖控制水平4.0-6.1 mmol/L、〉6.1-10.0 mmol/L、〉10.0 mmol/L分为A、B、C组,比较各组间机械通气时间、ICU住院时间、医院感染发生率、病死率、低血糖发生率。结果：病死组患者入院初始血糖水平、急性生理功能和慢性健康状况评分系统Ⅱ评分均高于存活组（P〈0.05和P〈0.01）。A、B组医院感染发生率、病死率和机械通气时间均低于C组（P〈0.05-P〈0.01）,A组低血糖发生率均高于B、C组（P〈0.05）;A、B、C组ICU住院时间差异无统计学意义（P〉0.05）。结论：危重症患者应激性高血糖及其控制水平与疾病的严重程度和预后有关。

Objective： To explore the association of stress hyperglycemia and its control level with the prognosis of critically ill patients. Methods： Seven hundred and ten critically ill patients with stress hyperglycemia were included in the study. The patients were divided into survival group and death group according to the prognosis. The initial blood glucose after admission and the acute physiology chronic health evaluationⅡ（ APACHEⅡ） score were compared between the two groups. According to the control level of blood glucose,the patients were divided into group A（ 4. 0- 6. 1 mmol /L）,group B（ 〉6. 1- 10. 0 mmol /L） and group C（ 〉10. 0 mmol /L）. The mechanical ventilation time,hospital stay time in ICU,incidence of nosocomial infection,mortality and morbidity of hypoglycemia were compared among different groups. Results： The initial blood glucose after admission and APACHEⅡ score in the death group were higher than those in the survival group（ P〈0. 05 and P〈0. 01）. The incidence rates of nosocomial infection,mortality and mechanical ventilation time in group A and group B were lower than those in group C（ P〈 0. 05 to P〈0. 01）. The morbidity of hypoglycemia in group A was higher than that in group B and group C（ P〈 0. 05）. There was no significant difference in admission days in ICU among the three groups（ P〉 0. 05）. Conclusions： Stress hyperglycemia and its control level of critically ill patients are correlated with the severity of the disease and the prognosis.