重症老年患者肠外营养的血糖管理的临床研究

Clinical effects of parenteral nutrition management for blood glucose in severe elderly patients

目的:了解重症老年患者应用肠外营养的血糖管理情况及对28 d病死率的影响。方法:选取2015年5月15日至7月15日河北省25家三级甲等医院重症医学科(intensive care unit, ICU)收治的所有应用肠外营养的重症老年患者作为调查对象。根据患者28 d生存与否分为生存组和死亡组,对2组血糖监测情况进行统计分析。结果:2组患者性别、入科分类、入科诊断及住ICU时间比较差异均无统计学意义(P>0. 05),单因素分析结果显示,28d病死率与APACHEⅡ评分、血糖最高值、血糖最低值、血糖波动值有关(P<0.05),多因素回归分析结果显示,血糖最高值和血糖波动值均为28d病死率的危险因素(OR=1.263,OR=1.159)。结论:应加强对应用肠外营养的重症老年患者的血糖监测及管理,根据血糖监测指标调整胰岛素用量,避免低血糖及血糖波动。

ObjectiveThe aim of this study was to understand management on blood glucose of critically old patients received parenteral nutrition and influence on 28-day mortality.MethodsCritically old patients received parenteral nutrition in 25 intensive care units of Tertiary Hospital from May 15th 2015 to July 15th 2015 in Hebei Province,were divided into survival group and death group according to the 28 d survivorship.The values of blood glucose were compared between two groups. ResultsThere was no significant difference in gender,admission classification,admission diagnosis and residence time between death group and survival group（P〉0.05）.APACHE Ⅱ score,the highest blood glucose,the minimal blood glucose and blood glucose fluctuation was associated with 28 d mortality（P〈0.05）.The highest blood glucose and blood glucose fluctuation were both risk factors of 28 d mortality（RR=1.263,RR=1.159） by multi-factor regression analysis.ConclusionClinicians should pay more attention to blood glucose monitoring in critically old patients received parenteral nutrition,and to adjust insulin dosage according to glucose monitoring index so as to avoid hypoglycemia and glucose fluctuation.