基础血糖水平分布与重症患者危重程度及预后关联性研究  

Relations of basic blood glucose level distribution and prognosis in critical diseases

作　　者：冯涛[1] 曹相原[2] 杨晓军[2] 王晓红[2] 丁欢[2] 

机构地区：[1]宁夏医科大学,宁夏银川750004 [2]宁夏医科大学附属医院,宁夏银川750004

出　　处：《宁夏医学杂志》2010年第3期237-239,共3页Ningxia Medical Journal

摘　　要：目的研究重症患者早期基础血糖水平分布特点,分析其与危重病程度及预后间的相关性。方法根据入科监测的基础血糖值,将207例重症患者分成三组:A组,血糖<4.5mmol/L;B组,血糖4.5-8.3mmol/L;C组,血糖>8.3mmol/L,统计分析各组患者危重程度及预后指标。结果①入组患者血糖范围在0.58-22.08mmol/L,平均血糖水平为(7.39±3.05)mmol/L;②B组患者的APACHEⅡ评分(10.30±6.23)及乳酸值(1.46±0.99)mmol/L,均显著低于A组患者的(22.54±13.46)及(5.07±2.98)mmol/L和C组患者的(14.74±8.49)及(2.82±1.74)mmol/L,差异有统计学意义(P<0.05);③A组患者MODS发生率、感染发生率、血管活性药物使用率、28日生存率分别为75%、62.5%、50%、54.2%,与B、C组患者比较差异有统计学意义(P<0.01);④A组患者基础血糖水平与APACHEⅡ、GCS、MODS和SOFA评分及多巴胺用量均存在显著相关性,而C组仅与APACHEⅡ、GCS评分相关(P<0.01)。结论重症患者的基础血糖分布在4.5-8.3mmol/L范围具有较好的安全性,可能是最合理的控制水平。血糖浓度低于4.5mmol/L时可作为对患者病情及预后判断的重要指标。Objective To observe the distribution features of blood glucose level （BGL） and analyze the relationship between BGL and critical degree, prognosis in critical ills. Methods There were 207 critical patients who were tested early blood glucose in admitted 2 hours. According to tested BGL of earlier stress period, they were divided into three groups： Group A, BGL 〈4.5mmol/L; Group B, BGL 4.5 - 8.3mmol/L; Group C, BGL 〉 8.3mmol/L. Assessed their scores of APPCHE Ⅱ, GCS, MODS, SOFA and condition of infection, vasoactive drug utilization and prognosis. Analysed relationship bewteen early BGL and these parameter. Results The patients＇blood glucose range was 0.58 - 22.08mmol/L and mean BGL was 7.39 ± 3.05mmol/L; The APACHE Ⅱ score （ 10.30 ± 6.23 ） and the blood lactic acid value （ 1.46 ±0.99mmol/L） of Group B were significantly less than Group A （ 22.54± 13.46 ; 5.07 ± 2. 98mmol/L） and Group C （ 14.74± 8.49 ; 2.82 ± 1.74mmol/L） （ P 〈 0.05 ）. The incidence rates of MODS, infection, vasoactive drug utilization and 28th day survival rate in Group A were 75%, 62.5%, 50% and 54.2%, respectively. And they were significantly different to Group B and C （P 〈0.01 ） ; BGL in Group A was connected with scores of APACHE Ⅱ , GCS, MODS, SOFA and dopamine dosage, and BGL in Group C was only connected with score of APACHE Ⅱ and GCS （ P 〈 0.01 ）. Conclusion The main distribution of basic blood glucose level in critical patients during early period are in 4.5 - 8.3 mmol/L which has better prognosis and safety, and it may be considered to reasonable blood glucose level. When the blood glucose level 〈 4.5 mmol/L, it can reveal severe degree of critcal ill and worse prognosis.

关 键 词：血糖 APACHEⅡ评分 预后 

分 类 号：R459.7[医药卫生—急诊医学]