摘要
目的探讨血糖波动对重症监护病房（ICU）危重症患者预后的影响。方法回顾性分析90例ICU危重症患者的临床资料，监测入住ICU72h内血糖值，记录初始血糖（GluAdm）、平均血糖（GluAve）、血糖标准差（GluSD）、血糖变异系数（GluCV）。按患者预后分为存活组（49例）与死亡组（41例），比较两组间GluAdm、GluAve、GluSD、GluCV的差异，应用受试者工作特征曲线（ROC曲线）评价血糖波动与预后的相关性。根据GluSD、GluCV值平均分为4个亚组，比较各亚组间ICU病死率及院内病死率。结果死亡组患者G1uAdm、GluAve、GluSD、GluCV均明显高于存活组[GluAdm：（11．47±3．91）mmol／L比（9．23±2．96）mmol／L，GluAve：（9．22±1．31）mmol／L比（8．Z8±1．15）mmol／L，GluSD：（2．62±0．97）mmol／L比（1．66±0．64）mmol／L，GluCV：0．28±0．10比0．20±0．07，P均〈0．053；GluSD、GluCV的ROC曲线下面积（AUC）分别为0．782±0．049和0．757±0．053，明显高于GluAdm、GluAve的AuC（分别为0．669±0．058和0．690±0．056，P均〈0．05）。GluSD4．35～5．66mmol／L组ICU病死率为95．7％，院内病死率为98．6％；GluCV0．378－0．500组ICU病死率为83．3％，院内病死率为100．0％。结论GluSD、GluCV升高与危重症患者ICU病死率和院内病死率显著相关，较GluAdm、GluAve评价预后更准确；降低血糖波动是有效控制血糖的重要策略。
Objective To determine the assoeiation between glucose fluetuations and hospital mortality in intensive care unit （ICU） patients. Methods A retrospeetive study involving 90 eritically ill patients in ICU according to the patients＇ outcome were divided into survivors （49 cases） and nonsurvivors （41 cases）, in whom the blood glucose level was monitored in the first 72 hours, and the initial blood glucose （GluAdm）, the average blood glucose （GluAve）, glucose standard deviation （GIuSD）, coefficient of variation glucose （GluCV） were determined, then GluAdm, GluAve, GluSD, and GluCV were compared between survivors and nonsurvivors, and the receiver operating characteristic curve （ROC eurve） was applied to evaluate the assoeiation between blood glueose fluetuation and prognosis. According to the values of GluSD, GluCV, the critically patients were divided into four subgroups, and mortality in ICU and hospital was compared. Results The levels of GluAdm, GluAve, GluSD, GluCV of nonsurvivors were higher than those of survivors fGluAdm： （11.47 ± 3. 91） mmol/L vs. （9. 23 ± 2. 96） retool/L, GluAve： （9.22 ± 1.31） mmol/L vs. （8.28± 1.15） retool/L, GluSD： （2.62 ±0.97） mmol/L vs. （1.66±0.64） mmol/L, GluCV： 0.28± 0.10 vs. 0. 20±0. 07, all P〈0. 053. When ROC was applied, the area under the curve （AUC） of GluSD, GluCV were 0. 782±0. 049 and 0. 757±0. 053, they were higher than that of the GluAdm and GluAve （0. 669±0. 058 and 0. 690±0. 056, both P〈0. 05）. When GluSD was 4.35 -5.66 mmol/L, the ICU mortality was 95.7%, hospital mortality was 98.6%; when GluCV was 0. 378 -0.500, the ICU mortality was 83.3%, hospital mortality was 100. 0%. Conclusion The increase in GluSD and GluCV in critically ill patients is significantly correlated with ICU mortality and hospital mortality, and they are more valuable in predicting ICU mortality than GluAdm, GluAve. Diminution in fluctuation of blood glucose might be an important aspect of glucose management.
出处
《中国危重病急救医学》
CAS
CSCD
北大核心
2009年第8期466-469,共4页
Chinese Critical Care Medicine
关键词
危重症
血糖波动
预后
强化胰岛素治疗
critical illness
blood glucose variability
prognosis
intensive insulin therapy
