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急危重症脑血管病患者血糖变异性、NIHSS评分、APACHEⅡ评分及预后分析 被引量:5

Blood glucose variability,NIHSS score,APACHEⅡscore,and prognosis in patients with acute and severe cerebrovascular disease
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摘要 目的探讨急危重症脑血管病患者血糖变异性、美国国立卫生研究院卒中量表(NIHSS)评分、急性生理与慢性健康评分Ⅱ(APACHEⅡ)评分及其与预后的关系,旨在为临床治疗提供参考依据。方法回顾性分析杭州市西溪医院于2014年1月至2019年12月收治的76例急危重症脑血管病患者临床资料,根据入院治疗后28 d的预后情况分为存活组(51例)和死亡组(25例),比较两组入院时一般资料、NIHSS基线评分、APACHEⅡ评分、血糖标准差(GluSD)、血糖值平均值(GluAve)、平均血糖波动幅度(GluMAGE)、血糖变异率(GluCV),分析其对急危重症脑血管病预后的影响。结果两组性别、年龄、糖尿病病史、疾病类型、住院时间比较,均差异无统计学意义(χ^(2)=1.674、t=1.048、χ^(2)=3.833、0.263,t=0.832,均P>0.05)。死亡组高血压病史[15.69%(8/51)]明显高于存活组[52.00%(13/25)],差异有统计学意义(χ^(2)=11.063,P<0.05)。两组GluAve差异无统计学意义(t=0.118,P>0.05)。死亡组基线NIHSS评分、APACHEⅡ评分、GluSD、GluMAGE、GluCV[(24.41±4.14)分、(25.00±6.97)分、(2.72±0.91)mmol/L、(6.27±2.01)mmol/L、(34.83±5.61)%]均明显高于存活组[(17.22±3.63)分、(19.21±5.36)分、(1.69±0.70)mmol/L、(3.72±1.68)mmol/L、(19.54±3.22)%],均差异有统计学意义(t=7.744、3.999、5.448、5.823、15.095,均P<0.05)。死亡组GluGV<20%的患者为16.00%(4/25),明显少于存活组的74.51%(38/51);GluGV>30%的患者为60.00%(15/25),明显多于存活组的13.73%(7/51),均差异有统计学意义(χ^(2)=23.230、17.466,均P<0.05)。经logistic回归分析显示,基线NIHSS评分、APACHEⅡ评分、GluSD、GluMAGE、GluCV均是影响脑血管病患者死亡的独立危险因素(均P<0.05)。结论在预后较差的急危重症脑血管病患者中,有明显血糖波动范围大、基线NIHSS评分和APACHEⅡ评分高的表现,其检测有助于评估患者预后,判断死亡风险。 Objective To investigate blood glucose variability,National Institutes of Health Stroke Scale(NIHSS)score,Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)score and prognosis in patients with acute and severe cerebrovascular disease,providing a reference for clinical treatment of this disease.Methods The clinical data of 76 patients with acute and severe cerebrovascular disease who received treatment in Xixi Hospital of Hangzhou between January 2014 and December 2019 were retrospectively analyzed.These patients were divided into a survival group(n=51)and a death group(n=25)according to the prognosis 28 days after admission.Baseline data,baseline NIHSS score,APACHEⅡscore,standard deviation of blood glucose,mean blood glucose,mean amplitude of glycemic excursions,and blood glucose variability rate were compared between the survival and death groups.The effects of these parameters on the prognosis of acute and severe cerebrovascular disease were analyzed.Results There were no significant differences in gender,age,history of diabetes,type of disease,and length of hospital stay between the two groups(χ^(2)=1.674,t=1.048,χ^(2)=3.833,0.263,t=0.832,all P>0.05).The proportion of patients with a history of hypertension in the death group was significantly higher than that in the survival group[15.69%(8/51)vs.52.00%(13/25),χ^(2)=11.063,P<0.05].There was no significant difference in mean blood glucose between the two groups(t=0.118,P>0.05).The baseline NIHSS score,APACHEⅡscore,standard deviation of blood glucose,mean amplitude of glycemic excursions and blood glucose variability rate in the death group were(24.41±4.14)points,(25.00±6.97)points,(2.72±0.91)mmol/L,(6.27±2.01)mmol/L,(34.83±5.61)%,which were significantly higher than those in the survival group[(17.22±3.63)points,(19.21±5.36)points,(1.69±0.70)mmol/L,(3.72±1.68)mmol/L,(19.54±3.22)%,t=7.744,3.999,5.448,5.823,15.095,all P<0.05].The proportion of patients with blood glucose variability rate<20%in the death group was significantly lower than that in the survival group[16.00%(4/25)vs.74.51%(38/51),χ^(2)=23.230,P<0.05].The proportion of patients with blood glucose variability rate>30%in the death group was significantly higher than that in the survival group[60.00%(15/25)vs.13.73%(7/51),χ^(2)=17.466,P<0.05).Logistic regression analysis revealed that baseline NIHSS score,APACHEⅡscore,standard deviation of blood glucose,mean amplitude of glycemic excursions,and blood glucose variability rate were the independent risk factors of death of cerebrovascular disease patients(all P<0.05).Conclusion In patients with acute and severe cerebrovascular disease,an obvious blood glucose fluctuation,high baseline NIHSS score,and high APACHEⅡscore help to assess the prognosis of acute and severe cerebrovascular disease and determine the risk of death.
作者 邱志磊 张思泉 周可幸 Qiu Zhilei;Zhang Siquan;Zhou Kexing(Department of Emergency,Xixi Hospital of Hangzhou,Affiliated Hangzhou Xixi Hospital of Zhejiang University of Traditional Chinese Medicine,Hangzhou 310023,Zhejiang Province,China;Intensive Care Unit,Xixi Hospital of Hangzhou,Affiliated Hangzhou Xixi Hospital of Zhejiang University of Traditional Chinese Medicine,Hangzhou 310023,Zhejiang Province,China)
出处 《中国基层医药》 CAS 2021年第7期992-996,共5页 Chinese Journal of Primary Medicine and Pharmacy
关键词 脑血管意外 危重病 血糖 氧化性应激 预后 危险因素 急性病生理学和长期健康评价 美国国立卫生研究院卒中量表 Cerebrovascular accident Critical illness Blood glucose Oxidative stress Prognosis Risk factors APACHE NIHSS
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