血糖变异性对重症急性卒中患者3个月内死亡风险的影响

Influence of glucose variability on mortality risks of severe acute stroke patients 3 months after admission

目的:探讨血糖变异性对重症急性卒中患者3个月内死亡风险的影响。方法:回顾性分析我院2016年1月至2018年1月接收的162例重症急性卒中患者,安排入住神经内科重症监护病房,并根据患者入院后3个月的生存情况将其分为生存组与死亡组,记录所有患者的初始血糖、血糖平均数、标准差、变异系数来衡量血糖变异性,并比较两组患者基线美国国立卫生研究院卒中量表(national institutes of health stroke scale,NIHSS)评分、急性生理与慢性健康评分Ⅱ(acute physiology and chronic health evahationⅡ,APACHEⅡ)评分,分析血糖变异性与重症急性卒中患者预后的相关性。结果:调查本组162例患者入院后3个月的生存状况发现,生存组132例,死亡组30例。对比两组患者的一般资料发现,两组患者APACHEⅡ评分和NIHSS评分差异有统计学意义(P<0.05);生存组与死亡组患者在初始血糖、血糖均数以及标准差、变异系数等方面差异有统计学意义(P<0.05)。另外根据平均血糖变异系数将患者分为3组(<30%、30%~50%和>50%),发现死亡组血糖变异系数>50%的患者占60%,明显高于血糖变异系数为<30%和30%~50%的患者(16.67%、23.33%);生存组血糖变异系数小于30%的患者占49.24%,明显高于血糖变异系数为30%~50%和>50%的患者(35.60%、15.15%),组间差异均有统计学意义(P<0.05)。将上述有差异资料代入logistic回归方程计算,发现基线APACHEⅡ评分、NIHSS评分以及初始血糖、血糖均数、血糖标准差、血糖变异系数是重症急性卒中患者3个月内死亡的独立预测因素。结论:血糖变异性对重症急性卒中患者3个月内死亡风险预测具有较高的应用价值,是潜在的预后评估指标。

Objective:To explore the effects of glucose variability on mortality risks of severe acute stroke patients 3 months after admission.Methods:Totally,162 severe acute stroke patients(from January 2016 to January 2018)in ICU were retrospectively analyzed.According to survival conditions 3 months after admission,patients were assigned to survived group and dead group.The initial glucose levels,average glucose levels,glucose standard deviations,and variable coefficients were recorded to measure the glucose variability.National Institutes of Health Stroke scale(NIHSS)scores at baseline and Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)scores between groups were compared.The correlation of glucose variability with patient’s prognosis was analyzed.Results:Three months after admission,the survey results showed 132 survived cases and 30 dead cases;it was significantly different in the APACHEⅡand NIHSS scores between the groups(P<0.05);and the initial glucose levels,average glucose levels,glucose standard deviations,and variable coefficients were statistically different between the two groups(P<0.05).According to variable coefficients of average glucose levels,patients were assigned to<30%group,30%to 50%group,and>50%group.The proportion of patients with glucose variability over 50%in dead group(60%)was found to be significantly higher than that of patients with glucose variability<30%and 30%to 50%(16.67%,23.33%).The proportion of patients with glucose variability<30%in survived group(49.24%)was found to be significantly higher than that of patients with glucose variability 30%to 50%and>50%(35.60%,15.15%);the difference was statistically significant(P<0.05).Logistic regression analysis indicated that the independent predictive factors of mortality risks 3 months after admission included baseline APACHEⅡscores,NIHSS scores,initial glucose levels,average glucose levels,glucose standard deviations,and variable coefficients.Conclusions:The glucose variability is proved to have high predictive value on mortality risks 3 months after admission.Therefore,it can be served as an important predictive indicator for patient’s prognosis.