神经内科重症监护室脑卒中患者高血糖控制现状

Analysis of hyperglycemia condition in patients with stroke in neurological intensive care unit

目的分析入住神经内科重症监护室(NICU)的脑卒中患者高血糖控制状况并探讨血糖水平与死亡风险的关系。方法纳入2017年7月~2018年12月入住NICU时发生高血糖的脑卒中患者进行回顾性分析,将其分为死亡组和存活组,比较两组之间血糖控制状况的差异,及其与死亡风险的关系。结果共纳入395例高血糖患者,其中死亡组22例,存活组373例。与存活组相比,死亡组的平均年龄(岁)(78.86±11.13 vs 67.81±16.04,P<0.01)、APACHEⅡ评分(分)(12.9±3.92 vs 10.78±3.01,P<0.05)、平均血糖值(mmol/L)(12.93±5.49 vs 10.7±4.56,P<0.01)、高血糖发生率(血糖>7.8 mmol/L)(83.31%vs 68.55%,P<0.01)、严重高血糖发生率(血糖>13.9 mmol/L)(36.01%vs 21.65%,P<0.01)、临床显著低血糖发生率(血糖<3.0 mmol/L)(0.28%vs 0.18%,P<0.05)、血糖漂移度(mmol/L)(4.20±1.44 vs 2.84±1.44,P<0.01)、最大血糖波动幅度(mmol/L)(17.34±8.48 vs 11.22±6.45,P<0.01)均明显增加,而目标血糖达标率(62.47%vs 78.07%,P<0.01)明显降低。多因素分析显示年龄(OR=1.083)、APACHEⅡ评分(OR=1.282)、平均血糖值(OR=1.424)是脑卒中合并高血糖患者死亡的独立危险因素。结论NICU住院脑卒中患者高血糖发生率高,血糖波动幅度大,尤其在死亡患者中更为明显,应重视血糖管理;其年龄、APACHEⅡ评分、平均血糖水平可能是死亡率增加的独立危险因素。

Objective To investigate and analyze the hyperglycemia condition in patients with stroke Neurological Intensive Care Unit(NICU),and study the relation between blood glucose level and the risk of mortality.Methods A retrospective analysis involving hyperglycemic patients with stroke admitted to NICU from July 1,2017 to December 31,2018 was conducted.Based on outcomes,these patients were divided into survival group and dead group。The difference of blood glucose condition between the two groups and the relation between blood glucose level and the risk of mortality were analyzed.Results 395 hyperglycemic patients were involved,including 22 in the dead group and 373 in the survival group.Compared with the survival group,the average age(78.86±11.13 vs 67.81±16.04,P<0.01),Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)(score)(12.9±3.92 vs 10.78±3.01,P<0.05),mean blood glucose(mmol/L)(12.93±5.49 vs 10.7±4.56,P<0.01),incidence of hyperglycemia(blood glucose>7.8 mmol/L)(83.31%vs 68.55%,P<0.01),incidence of severe hyperglycemia(blood glucose>13.9 mmol/L)(36.01%vs 21.65%,P<0.01),incidence of severe hypoglycemia(blood glucose<3.0 mmol/L)(0.28%vs 0.18%,P<0.05),standard deviation of blood glucose(mmol/L)(4.20±1.44 vs 2.84±1.44,P<0.01),largest fluctuation range of blood glucose(mmol/L)(17.34±8.48 vs 11.22±6.45,P<0.01)in the dead group increased significantly,while the control rate(62.47%vs 78.07%,P<0.01)decreased.Multivariate analysis showed that age(OR=1.083),APACHEⅡ(OR=1.282)and mean blood glucose(OR=1.424)were independent risk factors for mortality in hyperglycemic patients with stroke.Conclusion The hospitalized patients with stroke in NICU had a high incidence of hyperglycemia and a large fluctuation of blood glucose,especially in the dead patients.We should pay more attention to blood glucose management.Age,APACHEⅡand mean blood glucose may be the independent risk factors for mortality.