应激性高血糖对ICU危重症患者的影响及预防措施

Effect of Stress Hyperglycemia on ICU Critically Ill Patients and Its Preventive Measures

目的:分析应激性高血糖对ICU危重症患者的影响,探讨预防措施。方法:选择某院ICU 2016年10月~2017年10月接收的危重症患者93例,依据血糖监测结果,分为观察组(伴应激性高血糖,n=61)和对照组(血糖正常,n=32),观察住院情况及预后情况;观察组均给予胰岛素治疗,根据血糖控制目标,分为A组(血糖控制目标4.1~6.0mmol/L,n=18)、B组(血糖控制目标6.1~8.0mmol/L,n=26)、C组(血糖控制目标8.1~11.1mmol/L,n=17),观察患者住院情况及预后情况。结果:观察组患者住ICU时间、死亡率、IL-6、CRP水平均高于对照组;A组、B组住ICU时间、IL-6、CRP水平、死亡率低于C组,且B组低于A组;A组低血糖发生率高于B组、C组;A组、B组医院感染、MODS发生率低于C组。以上差异均显著(P<0.05)。结论:应激性高血糖会严重影响患者预后,确诊后,血糖控制目标为6.1~8.0mmol/L时,可使患者预后有效改善,应在患者进入ICU时即给予积极预防,减少应激性高血糖的发生。

Objective：To analyze the effect of stress hyperglycemia on IUC critical patients and to explore the preventive measures.Methods：93 cases of critically ill patients treated in a hospital from October 2016 to October 2017 were selected and divide into observation group（61 cases）and control group（32 cases）,andthe situation and prognosis were observed;The observation group were all given insulin therapy,and according to the goal of blood glucose control,the patients were divided into group A（glycemic control target of 4.1～6.0 mmol/L,n=18）,group B（glycemic control target of 6.1～8.0 mmol/L,n=26）,and group C（glycemic control target of 8.1～11.1 mmol/L,n=17）,then the patients condition and prognosis were observed.Results：The ICU duration,mortality and IL-6 CRP levels in the observation group were higher than those in the control group;The ICU duration,level of IL-6,CRP and mortality in group A and B were lower than those of group C,and group B was lower than group A;The incidence of hypoglycemia in group A is higher than that in group B and group C;The incidence of hospital infection and MODS in group A and group B was lower than that in group C.The differences were significant（P〈0.05）.Conclusion：Stress hyperglycemia can seriously affect the prognosis of patients.After the diagnosis,when the goal of blood glucose control is 6.1～8.0 mmol/L,the prognosis of patients can be improved effectively.The patients should be actively prevented when they enter ICU,and the occurrence of stress hyperglycemia should be reduced.