重症呼吸衰竭无创通气治疗患者应激性高血糖发生状况及其影响因素

The occurrence and influencing factors of stress hyperglycemia in patients with severe respiratory failure treated with non-invasive ventilation

目的:探讨重症呼吸衰竭无创通气治疗患者应激性高血糖发生状况及其影响因素。方法:回顾性分析2019-01~2019-12于我院重症医学科行无创正压通气治疗的重症呼吸衰竭78例患者基本临床资料,分析受试者在无创通气治疗前和治疗后应激性高血糖发生情况;针对影响患者应激性高血糖因素进行多因素Logistic回归分析。结果:78例重症呼吸衰竭无创通气治疗患者,其中19例患者出现应激性高血糖,占24.4%。行无创正压通气治疗后第1天空腹血糖为(6.3±0.8)mmol/L,无创正压通气治疗后第2~7天,空腹血糖值逐渐增高,治疗后第7天空腹血糖达最高值(9.1±1.1)mmol/L,随后血糖逐渐降低,治疗后第10天空腹血糖降至(5.6±0.5)mmol/L;多因素Logistic回归分析表明,患者并发应激性高血糖的影响因素为年龄、激素治疗、抑郁状态、焦虑状态及营养方式。结论:重症呼吸衰竭无创正压通气治疗患者并发应激性高血糖的几率较高,在通气治疗过程中,应加强对患者心理疏导,尽量减少肠外营养方式的应用,密切监测患者血糖水平。

Objective:To investigate the occurrence and influencing factors of stress hyperglycemia in patients with severe respiratory failure treated with non-invasive ventilation.Methods:The basic clinical data of 78 patients with severe respiratory failure who received non-invasive positive pressure ventilation in the ICU Department of the Fifth Affiliated Hospital of Zhengzhou University from January 2019 to December 2019 were retrospectively analyzed.The incidence of stress hyperglycemia in subjects before and after non-invasive ventilation treatment was analyzed.Multivariate Logistic regression analysis was conducted for the factors affecting stress hyperglycemia.Results:Stress hyperglycemia occurred in 19(24.4%)of 78 patients with severe respiratory failure treated with non-invasive ventilation.On the first day after treatment with NPPV,fasting blood glucose was(6.3±0.8)mmol/L.On the second to seventh day after treatment with NPPV,fasting blood glucose gradually increased,and reached the highest value(9.1±1.1)mmol/L on the seventh day,and then decreased gradually.Fasting blood glucose decreased to(5.6±0.5)mmol/L on the 10th day after treatment.Multivariate Logistic regression analysis showed that the influencing factors of patients with stress hyperglycemia were age,hormone therapy,depression,anxiety and nutritional mode.Conclusion:Severe respiratory failure patients treated with non-invasive positive pressure ventilation have a high incidence of stress hyperglycemia.In the process of ventilation treatment,psychological counseling should be strengthened for patients,parenteral nutrition should be minimized,and blood glucose levels of patients should be closely monitored.