糖代谢紊乱检测对脓毒症患儿预后的影响

Prognosis of sugar metabolic disorder early detection on sepsis children

目的研究糖代谢紊乱检测对儿科重症监护病房(pediatric intensive care unit,PICU)脓毒症患儿预后的影响。方法收集2015年1~12月本院PICU的68例脓毒症患儿,按照病情严重程度分为脓毒性休克组、严重脓毒症组、脓毒症组。按照疾病转归不同分为存活组和死亡组。比较疾病转归和病情严重程度不同组别间的临床资料和血糖参数,对各项指标和预后之间的相关性予以分析。结果存活组和死亡组的年龄、性别、上呼吸机时间比较差异无显著性(P>0.05),存活组的总住院时间、PICU治疗时间显著长于死亡组[(18.54±2.45)天、(6.87±0.69)天vs(4.35±0.43)天、(2.89±0.24)天;P<0.05],病情分级中存活组的极危重比例显著低于死亡组[15.38%(6/39)vs 51.72%(15/29);P<0.05]。存活组和死亡组的血糖平均值、入科血糖比较差异无显著性(P>0.05),存活组的高血糖、血糖差值显著低于死亡组[(8.32±1.15)mmol/L、(4.14±0.42)mmol/L vs(10.43±1.55)mmol/L、(5.75±0.59)mmol/L],低血糖显著高于死亡组[(3.78±1.14)mmol/L vs(2.17±0.36)mmol/L],差异均有显著性(P<0.05)。脓毒症组的总住院时间显著短于严重脓毒症组、脓毒症休克组(P<0.05),病情分级中脓毒症组的非危重比例显著高于严重脓毒症组、脓毒症休克组(P<0.05)。脓毒症组的高血糖、血糖差值显著低于严重脓毒症组和脓毒症休克组,低血糖值显著高于严重脓毒症组和脓毒症休克组,差异均有显著性(P<0.05)。总住院时间、PICU时间、小儿危重症评分法(pediatric critical illness score,PCIS)评分、低血糖和患儿的预后呈负相关(P<0.05),高血糖、血糖差值和患儿的预后呈正相关(P<0.05)。结论总住院时间、PICU时间、PCIS评分、低血糖、高血糖、血糖差值和患儿的预后存在着密切的关联性,通过检测糖代谢紊乱指标有利于预测脓毒症患儿的预后。

Objective To study the prognosis of sugar metabolic disorder early detection on PICU sepsis children. Method From January to December in 2015, 68 cases of PICU sepsis children selected in our hospital was divided into septic shock group, severe sepsis group, sepsis group according to the illness severity which was divided into survival group and death group according to the different disease outcome. The disease outcome and illness severity between different groups of clinical data and the parameter of the blood sugar were compared, and the correlation between the indicators and prognosis were analyzed. Result The survival group and death group on age, gender, breathing machine time had no significant difference（P〉0.05）, survival group, the total length of hospital stay, PICU treatment time were significantly longer than the death group [（18.54±2.45）days,（6.87±0.69）days vs（4.35±0.43）days,（2.89±0.24）days; P〈0.05], the disease classification of live extremely critical proportion was significantly lower than death group [15.38%（6/39） vs 51.72%（15/29）; P〈0.05]. Average survival group and death group with blood sugar, the blood sugar had no significant difference（P〉0.05）, high blood sugar, blood sugar difference in the survival group was significantly lower than the death group [（8.32±1.15）mmol/L,（4.14±0.42）mmol/L vs（10.43±1.55）mmol/L,（5.75±0.59）mmol/L], hypoglycemia was significantly higher than the death group [（3.78±1.14）mmol/L vs（2.17±0.36）mmol/L], the difference had statistical significance（P〈0.05）. Sepsis group, the total length of hospital stay was significantly shorter than severe sepsis, sepsis shock group（P〈0.05）, the disease classification of proportions of critically ill in sepsis group significantly higher than the severe sepsis, sepsis shock group（P〈0.05）. Sepsis group of high blood sugar, blood sugar difference significantly lower than severe sepsis and sepsis shock groups, low blood sugar value was significantly higher than severe sepsis and sepsis shock groups, differences were statistically significant（P〈0.05）. Total length of hospital stay, time of PICU, PCIS score, hypoglycemia and the prognosis of children showed negative correlation（P〈0.05）, and the prognosis of children with high blood sugar, blood sugar difference showed positive correlation（P〈0.05）. Conclusion The total length of hospital stay, time of PICU, PCIS score difference, low blood sugar, high blood sugar, blood sugar, which have a close correlation with the prognosis of children, by testing the sugar metabolic disorders index can predict the prognosis of children with sepsis.