血糖和糖皮质激素在危重病应激监测中的意义

Significance of serum glucose and glucocorticosteroid hormone on the monitoring of stress response in critical illness patients

目的 探讨应激状态下血糖和皮质醇的变化规律及其与危重病严重程度和预后的关系 ,为危重病患者的代谢支持选择最佳时机。方法 ICU危重病患者 12 7例 ,入选标准为各种原因所致的SIRS和MODS。回顾性将病例分为死亡组(n =35 )和存活组 (n =92 )。入院后当天、3、5、7、14d进行血糖检查 ,入院后次日、5、10d进行循环血内皮质醇检测。 30例接受重组人生长激素治疗的患者对其内环境进行了监测。结果 死亡组患者血糖一直维持于较高水平 ,对胰岛素存在一定的耐受性。存活组患者治疗后血糖和胰岛素用量进行性下降 ;生长激素明显提高两组患者血糖水平 (P <0 0 1) ,增加危重病患者内环境紊乱。循环血皮质醇浓度显示死亡组患者一直处于较高水平 ,而存活组呈进行性下降 (P <0 0 1)。结论 血糖水平和循环血内皮质醇浓度走势相一致 ,可作为危重病患者应激反应病理过程的一个监测指标 ,同时为危重病患者的预后提供一个参考指标 ;生长激素在应激期增加危重病患者的内环境紊乱。

Objective To study the clinical significance of serum glucose and glucocorticosteroid hormone on the monitoring of stress response in critical illness patients.Methods 127 critical illness patients in ICU,who suffered from SIRS and MODS,were enrolled in this study and divided into two groups,survival group(n=92)and dead group(n=35),retrospectively.Serum glucose was monitored immediately after hospitalization and 1,3,5,7,and 14 days later.The level of serum glucocorticosteroid was tested 2,5,10 days after the hospitalization.Effect of human growth hormone on the level of serum glucose was also observed in those critical illness patients.Results The serum glucose in dead group maintained high level and was not sensitive to insulin,whereas serum glucose in survival group dropped progressively and the amount of insulin used for those patients was also declined.Human growth hormone obviously increased the level of serum glucose and aggravated the disorder of internal environment in both groups.The level of serum glucocorticosteroid was higher in dead group and decreased step by step in survival group( P <0 01).Conclusion The level of serum glucose coincided with that of glucocorticosteroid in critical illness patients.Serum glucose can be used as a marker for stress response in critical illness.