急诊多发伤患者血糖变异和APACHEⅡ评分与预后的关系

The Relationship Between Blood Glucose Variability,APACHEⅡScore and Prognosis in Patients with Multiple Injuries in Emergency Department

目的探讨多发伤患者血糖变异和急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分与预后的关系。方法选择2017年7月~2019年12月我院急诊科收治的多发伤患者124例,以28 d是否死亡作为终点分为生存组和死亡组,比较两组血糖指标、APACHEⅡ评分,分析不同APACHEⅡ评分的患者血糖及预后、不同水平血糖值患者APACHEⅡ评分及预后,并采用直线相关回归分析血糖水平与APACHEⅡ评分的关系,Logistic回归分析多发伤患者28 d死亡的危险因素。结果124例患者中死亡29例,死亡率为23.39%;两组入住ICU 48 h血糖平均值比较,差异无统计学意义(P>0.05);死亡组APACHEⅡ评分、初始血糖、GLUSD、GLUCV、GLI、胰岛素用量高于生存组,差异有统计学差异(P<0.05)。不同APACHEⅡ评分患者初始血糖及死亡率比较,差异有统计学意义(P<0.05);不同水平血糖值患者APACHEⅡ评分及死亡率比较,差异有统计学意义(P<0.05);经直线相关分析显示,血糖水平与APACHEⅡ评分呈正相关(r=0.702,P<0.05);Logistic回归分析显示,GLUSD、GLUCV、GL和APACHEⅡ评分是患者28 d死亡的独立危险因素。结论多发伤患者入院时的血糖水平与APACHEⅡ评分密切相关,对多发伤患者的病情诊断和预后判断具有重要意义。

Objective To explore the relationship between blood glucose variability,acute physiology and chronic health status scoring systemⅡ(APACHEⅡ)score and prognosis in patients with multiple injuries.Methods A total of 124 patients with multiple injuries who were admitted to the emergency department of our hospital from July 2017 to December 2019 were selected and divided into survival group and death group with 28 d of death as the end point.Compare the two groups of blood glucose indicators and APACHEⅡscores,analyze the blood glucose and prognosis of patients with different APACHEⅡscores,and analyze the APACHEⅡscores and prognosis of patients with different blood glucose levels,and use linear regression to analyze the relationship between blood glucose levels and APACHEⅡscores.Logistic regression analyzed the risk factors of 28 d death in patients with multiple injuries.Results 29 of the 124 patients died,and the mortality rate was 23.39%.There was no significant difference in the average blood glucose between the two groups in ICU 48 h(P>0.05);The APACHEⅡscore,initial blood glucose,GLUSD,GLUCV,GLI,and insulin dosage in the death group were higher than those in the survival group,the difference was statistically significant(P<0.05).The comparison of initial blood glucose and mortality of patients with different APACHEⅡscores was statistically significant(P<0.05);comparison of APACHEⅡscores and mortality of patients with different levels of blood glucose levels was statistically significant(P<0.05);the linear correlation analysis shows that the blood glucose level is positively correlated with the APACHEⅡscore(r=0.702,P<0.05);Logistic regression analysis showed that GLUSD,GLUCV,GL and APACHEⅡscores were independent risk factors for 28 d death.Conclusion The blood glucose level of patients with multiple injuries at admission is closely related to the APACHEⅡscore,which is of great significance for the diagnosis and prognosis of patients with multiple injuries.In the early treatment of patients with multiple injuries,reducing blood glucose variability is an important aspect of blood glucose control.