低血糖对脓毒症患者住院死亡率影响的研究  

A study on the effect of hypoglycemia on in-hospital mortality in patients with sepsis

作　　者：刘秀娟[1] 崔久庆 路紫贺 张梅香 陈泽 Liu Xiujuan;Cui Jiuqing;Lu Zihe;Zhang Meixiang;Chen Ze(Department of Intensive Care Unit,The First Hospital of Qinhuangdao;Department of Intensive Care Unit,Hebei Petrochina Central Hospital,Langfang,China)

机构地区：[1]秦皇岛市第一医院重症医学科 [2]河北中石油中心医院重症医学科

出　　处：《实用休克杂志（中英文）》2022年第4期208-212,226,共6页Journal of Practical Shock

基　　金：秦皇岛市科学技术局2020年财政资金支持项目(项目编号:202003B025);秦皇岛市科技局市级科技计划项目(项目编号:201602A112);河北省卫生厅医学科学研究重点课题(项目编号:20171246)

摘　　要：目的探讨脓毒症患者住院期间发生低血糖对死亡率的影响,分析发生低血糖相关的危险因素。方法回顾性分析2017年6月至2020年3月秦皇岛市第一医院重症医学科收治的满足纳入标准的脓毒症患者临床资料。根据住院期间生存情况分为存活组和死亡组,比较组间APACHE II、SOFA、低血糖、血糖标准差等变量差异,二元Logistic回归分析找出影响疾病预后的独立危险因素;将患者分为低血糖组与非低血糖组,分析脓毒症患者发生低血糖的危险因素。结果总计纳入454例脓毒症患者,合并脓毒性休克197例(43.39%),平均年龄为(67.46±14.94)岁,APACHEⅡ[18.0(13.0,24.0)],SOFA[6.0(4.0,9.0)];男性284例(62.6%),女性170例(37.4%);存活组294人(64.8%),死亡组160人(35.2%);胰岛素降糖治疗134例(29.5%),其中糖尿病患者88例(65.7%);共收集26134个血糖数值,最高血糖值为44.8mmol/L、最低血糖值为0.6mmol/L,281人发生高血糖(61.9%),126人发生低血糖(27.8%),45人发生严重低血糖(9.9%)。死亡组APACHEⅡ、SOFA、低血糖发生率、严重低血糖发生率、血糖标准差、乳酸、使用胰岛素控制血糖比例显著高于存活组(P<0.05),二元Logistic回归分析提示低血糖是影响脓毒症患者预后的独立危险因素(OR=2.589,95%CI:0.162~0.413,P=0.000)。低血糖组在APACHEⅡ、SOFA、机械通气比例、心功能不全、脑血管病、肾功能不全等基础疾病均显著高于非低血糖组(P<0.05),二元Logistic回归分析表明APACHEⅡ、CRRT是脓毒症患者发生低血糖的独立危险因素。结论低血糖是影响脓毒症患者预后的独立危险因素,低血糖发生与疾病严重程度相关,进行CRRT的患者低血糖发生率可能会增加。Objective To investigate the effect of hypoglycemia on the mortality rate of hospitalized patients with sepsis and to analyze the risk factors associated with hypoglycemia.Methods We retrospectively analyzed the clinical data of septic patients meeting the criteria for inclusion in the Department of Critical Care Medicine in the First Hospital of Qinhuangdao,from June 2017 to March 2020.They were divided into survival group and death group according to the survival conditions during hospitalization.The differences of APACHEⅡ,SOFA,hypoglycemia,standard deviations of blood glucose and other variables were compared between groups;binary logistic regression analysis was used to find independent risk factors affecting the prognosis of the disease.The patients were divided into hypoglycemia group and non-hypoglycemic group,and the risk factors for hypoglycemia in septic patients were analyzed.Results A total of 454 septic patients,including 197(43.39%)patients with septic shock,the average age was(67.46±14.94)years,APACHEⅡ[18.0(13.0,24.0)],and SOFA[6.0(4.0,9.0)].There were 284 males(62.6%)and 170 females(37.4%).The survival group was 294(64.8%)and the death group was 160(35.2%).Insulin hypoglycemic therapy was performed in 134 patients(29.5%),including 88 patients with diabetes(65.7%).A total of 26,134 blood glucose values were collected.The highest blood glucose level was 44.8 mmol/L,the lowest blood glucose level was 0.6 mmol/L,281 patients had hyperglycemia(61.9%),126 patients had hypoglycemia(27.8%),and 45 patients had severely hypoglycemia(9.9%).The APACHEⅡ,SOFA,incidence of hypoglycemia,incidence of severe hypoglycemia,standard deviation of blood glucose,lactate,and insulin control blood glucose ratio were significantly higher in the death group than in the survival group(P<0.05).The binary logistic regression analysis suggested that hypoglycemia is an independent risk factor for the prognosis of patients with sepsis(OR=2.589,95%CI:0.162~0.413,P=0.000).Hypoglycemic group in APACHEⅡ,SOFA,ratio of mechanic

关 键 词：脓毒症 血糖管理 低血糖 死亡率 危险因素 

分 类 号：R459.7[医药卫生—急诊医学]