老年严重烧伤患者早期应激性高血糖的危险因素及其对预后的影响

目的回顾性分析老年严重烧伤患者早期应激性高血糖的危险因素,及其对预后的影响。方法选取2016年1月至2022年2月在中国科学院大学宁波华美医院烧伤整形科收治的123例老年严重烧伤患者为研究对象,根据入院72 h内是否2次空腹血糖值≥7.0 mmol/L或随机血糖值≥11.1 mmol/L,分为高血糖组(n=71)和对照组(n=52),分析两组患者一般临床资料(性别、年龄、烧伤总面积、深度烧伤面积、APACHEⅡ评分等)、72 h内的炎性指标白细胞计数(WBC)、C反应蛋白(CRP)、降钙素原(PCT)有无差异,单因素及多因素Logistic回归分析应激性高血糖的危险因素,并统计两组90 d病死率的差异。结果高血糖组平均年龄、烧伤总面积、深度烧伤面积及APACHE II评分均明显高于对照组,炎性指标WBC计数、CRP、PCT均明显高于对照组(P<0.05),90 d内病死率明显高于对照组(P<0.05)。多因素分析显示,烧伤总面积、深度烧伤面积、WBC、CRP是影响老年烧伤患者早期应激性高血糖的独立危险因素。结论老年严重烧伤患者早期应激性高血糖的发生与烧伤病情严重程度及炎症指标密切相关,而应激性高血糖又可促进病死率增加。

Objective To retrospectively analyze the risk factors of early stress hyperglycemia in elderly severe burn patients and their influence on prognosis.Methods From January 2016 to February 2022,123 elderly patients with severe burns who admitted to the Department of Burn and Plastic Surgery,Hwa Mei Hospital,University of Chinese Academy of Sciences(hereinafter referred to as the author's unit)were selected as the research subjects.According to whether the fasting blood glucose value≥7.0 mmol/L or the random blood glucose value≥11.1 mmol/L twice within 72 hours of admission,they were divided into hyperglycemia group(n=71)and control group(n=52).The general clinical data(gender,age,total burn area,deep burn area,APACHE II score,etc.),inflammatory markers white blood cell count(WBC),C-reactive protein(CRP),procalcitonin(PCT)is there any difference,univariate and multivariate logistic regression analysis was used to analyze the risk factors of stress hyperglycemia,and the differences in 90-day mortality between the two groups were calculated.Results The average age,total burn area,deep burn area and APACHE II score in the hyperglycemia group were significantly higher than those in the control group,and the inflammatory indexes WBC count,CRP and PCT were significantly higher than those in the control group(P<0.05),and the mortality rate within 90-days was significantly higher than the control group(P<0.05).Multivariate analysis showed that total burn area,deep burn area,WBC and CRP were independent risk factors for early stress hyperglycemia in elderly burn patients.Conclusion The occurrence of early stress hyperglycemia in elderly patients with severe burns is closely related to the severity of burns and inflammatory indicators,and stress hyperglycemia can promote the increase of mortality.