持续性高血糖是呼吸重症监护病房患者死亡的危险因素  

Persistent hyperglycemia as a risk factor for death of the patients in respiratory intensive care unit

作　　者：王建丽[1] 贺蓓[1] 赵鸣武[1] 姚婉贞[1] 

机构地区：[1]北京大学第三医院呼吸科,北京100083

出　　处：《中国呼吸与危重监护杂志》2006年第4期282-286,共5页Chinese Journal of Respiratory and Critical Care Medicine

摘　　要：目的 研究呼吸重症监护病房（RICU）患者血糖升高与预后的关系。方法 采用回顾性分析的方法，将2000年～2004年RICU收治的325例以呼吸系统感染为主或合并呼吸系统感染，并有入院次日清晨血糖检测结果者，分为糖尿病组（n=60）、非糖尿病性高血糖组（n=147）和血糖正常组（n=118）。非糖尿病性高血糖组患者再根据血糖是否在24h内恢复至6．1mmol／L以下分为一过性高血糖组（n=74）和持续性高血糖组（n=73）二个亚组。对血糖结果、平均住院日、死亡率及相关临床情况进行分析。结果 （1）非糖尿病性高血糖组入院APACHEⅡ评分和有创机械通气比例明显高于糖尿病组和血糖正常组；血浆白蛋白显著低于糖尿病组和血糖正常组；脏器受累分值和机械通气（包括有创和无创）比例明显高于血糖正常组；死亡率明显高于血糖正常组（37．4％比13．6％），与糖尿病组（26．7％）无显著差异；RICU住院日与糖尿病组和血糖正常组比较均无显著差异。糖尿病组死亡率显著高于血糖正常组。（2）持续性高血糖组血浆白蛋白低于其他三组，机械通气比例和有创机械通气比例、脏器受累分值、死亡率均高于其他三组，RICU住院日较血糖正常组和一过性高血糖组明显延长，与糖尿病组比较虽有延长，但差异无统计学意义（P=0．051）。APACHEⅡ评分高于糖尿病组和血糖正常组，与一过性高血糖组无明显差异。（3）一过性高血糖组RICU住院日和死亡率与糖尿病组和血糖正常组比较均无显著差异。结论 非糖尿病性高血糖在RICU发生率高，与已知糖尿病组和正常血糖者相比，新发生的持续性高血糖可能危险性更大。Objective To evaluate the association between hyperglycemia and clinical outcomes among patients with and without diabetes mellitas admitted to respiratory intensive care unit （RICU）. Methods 325 patients with respiratory infection who were admitted to RICU from 2000 to 2004 were analysed retrospectively. These patients were divided into diabetic group （with diagnosed diabetes, n = 60）, non-diabetic hyperglycemia group （n = 147） [which was divided into two subgroups：transient hyperglycemia group （blood glucose level≥ 6.1 mmol/L,and restored to be less than 6.1 mmol/L within 24 h,n = 74） and persistent hyperglycemia group （blood glucose level≥6.1 mmol/L and persisted more than 24 h, n = 73） ] and normoglycemic group （ with normal plasma glucose and no previous history of diabetes, n = 118）. The average length of RICU stay, mortality in RICU and other relative factors were compared betwween these groups. Results A. In the non-diabetic hyperglycemia group, the APACHE Ⅱ score and the proportion of patients required invasive mechanical ventilation were higher,and the mean blood albumin level was lower than other two groups （all P 〈 0.05）. The score of impaired organs and the proportion of patients required mechanical ventilation were higher than the normoglycemic group （P 〈 0.01）.The RICU mortality was higher than the normoglycemic group （37.4% vs 13.6%, P 〈 0.01）. The average length of RICU stay was longer than other two groups without significant differences. The mortality of the diabetic group was higher than the normoglycemic group （ P 〈 0.05）. B. In the persistent hyperglycemia group, the blood albumin level was lower than other three groups （ P 〈 0.01 ）. The propartion of patients required invasive mechanical ventilation, the proportion of patients required mechanical ventilation, the score of impaired organs, and the RICU mortality were higher than other three groups （ all P 〈 0.05）. The average length of RICU stay was longer than the normoglyc

关 键 词：持续性高血糖 呼吸重症监护病房 预后 

分 类 号：R587[医药卫生—内分泌] R563[医药卫生—内科学]