2型糖尿病对ICU机械通气患者呼吸机相关性肺炎的影响

Effect of type 2 diabetes mellitus on ventilator-associated pneumonia in ICU patients undergoing mechanical ventilation

目的探讨2型糖尿病对ICU接受机械通气患者呼吸机相关性肺炎(VAP)的病情变化有无影响。方法回顾性分析105例ICU接受机械通气的VAP患者,根据有无合并2型糖尿病,分为糖尿病组55例和对照组50例。收集患者的一般临床资料,包括性别、年龄、体重指数、有无鼻饲和基础疾病等。比较两组ICU住院时间、气管插管时间、MV持续时间、格拉斯哥昏迷评分(GCS)、急性生理学和慢性健康(APACHE)Ⅱ评分及4周内的全因死亡率。结果糖尿病组高血压、心脑血管病的发病率比对照组明显增高(P <0. 05)。糖尿病组GCS评分降低,APACHEⅡ评分明显增加,与对照组比较,差异均有统计学意义(P <0. 05)。糖尿病组和对照组4周内的全因死亡率分别为30. 9%和14. 0%,两组比较有明显的统计学差异(P=0. 039)。结论2型糖尿病对ICU接受机械通气VAP患者的生存产生明显的负面影响,是增加VAP患者死亡率的重要因素。

Objective To investigate the effect of type 2 diabetes on the changes of ventilator-associated pneumonia in ICU patients undergoing mechanical ventilation.Methods A retrospective analysis of 105 patients undergoing mechanical ventilation in ICU were divided into two groups depending on the history of diabetes,55 cases in the diabetes group and 50 cases in the control group.The clinical data were collected,including sex,age,body mass index,nasal feeding and primary disease.The hospitalization time,endotracheal intubation time,MV duration in ICU,Glasgow coma score(GCS),acute physiology and chronic health(APACHE)Ⅱscore and all-cause mortality within 4 weeks were compared between the two groups.Results The incidence of hypertension and cardio-cerebrovascular diseases in the diabetic group was significantly higher than that in the control group(P<0.05).The GCS score decreased and APACHEⅡscore increased more significantly in the diabetic group than in the control group(P<0.05).The all-cause mortality in the diabetic group and the control group within 4 weeks were 30.9%and 14%respectively,and there was a significant difference between the two groups(P=0.039).Conclusion Type 2 diabetes has a significant negative impact on the survival of VAP patients receiving mechanical ventilation in ICU,as an important factor in increasing the mortality.