血糖波动对重症患者预后影响的相关性研究

Correlation of Blood Glucose Variability with Mortality in Critical Ill Patients

目的探讨血糖波动对重症患者预后的影响。方法回顾性分析2013年6月至2014年2月苏州市中西医结合医院收治的79例入住重症监护病房(ICU)当日急性生理学与慢性健康状况评分Ⅱ(APACHE-Ⅱ)评分≥15分、住ICU时间≥3 d的危重症患者的临床资料,监测入住ICU 72 h内血糖值,记录初始血糖(Glu Adm)、72 h内平均血糖(Glu Ave)、血糖标准差(Glu SD)、血糖变异率(Glu CV)。根据入住ICU后28 d预后情况分为存活组(n=50)与死亡组(n=29)。比较两组间APACHE-Ⅱ评分、Glu Adm、Glu Ave、Glu SD、Glu CV的差异。结果死亡组患者APACHE-Ⅱ评分、Glu SD和Glu CV均显著高于存活组[(28±10)分比(20±8)分,(2.8±1.7)mmol/L比(1.9±0.7)mmol/L,(0.34±0.13)%比(0.23±0.07)%,P<0.01],Glu Adm、Glu Ave在存活组和死亡组间差异无统计学意义(P>0.05)。Pearson相关分析显示,Glu SD与APACHE-Ⅱ评分呈正相关(r=0.583,P<0.01)。结论危重患者血糖波动与28 d病死率密切相关,降低血糖波动有利于改善患者预后。

Objective To explore the correlation between glucose variability and mortality in critical patients. Methods Seventy-nine patients, with acute physiology and chronic health evalu-ation scoring system （APACHE-Ⅱ ） score on admission day ≥ 15, the duration of ICU stay ≥ 3 d, in ICU of Suzhou Integrated Traditional and Western Medicine Hospital from Jun. 2013 to Feb. 2014 were included in the study, according to the patientts prognosis on the 28th day,they were divided into survivor group（ n = 50） and nonsurvivor group（n =29）,and the blood glucose level in the first 72 b was monitors：the initial blood glucose（ Glu- Adm） ,the mean value of 72h（GluAve） , standard deviation of blood glucose（GIuSD） and variation coeffi- cient of blood glucose （ GIuCV ） of the two groups were recorded. APACHE- II score, GluAdm, GluAve, GIuSD, GIuCV of the two groups were compared. Results The levels of APACHE- ]I score, GIuSD and GIuCV of nonsurvior group were higher than those of survivor groupE APACHE- ]I （28 ± 10） vs （20± 8）, GIuSD （2. 8 ±1. 7 ） mmol/L vs （ 1. 9 ± 0. 7 ） mrnol/L, GIuCV （0. 34 ± 0. 13 ） % vs （0. 23 ± 0. 07 ） %, P 〈 0. 01 ] ,but there was no statistically significant difference in the levels of GluAdm and GluAve（P 〉0. 05）. Pearson correlation analysis showed that GluSD was positively correlated with APACHE- II score （ r = 0. 583, P 〈 0.01 ）. Conclualon Variability of blood glucose has close relation to short-term mortality （ 28 days）. Control of the fluctuation of blood glucose is helpful to improve the prognosis.