危重患者低血糖临床分析及对预后的影响  

Clinical analysis of hypoglycemia in critically ill patients and the effets on outcome

作　　者：杜云波[1] 王玉新[2] 

机构地区：[1]中山大学附属江门市中心医院重症医学科,广东江门529030 [2]中山大学附属江门市中心医院泌尿外科,广东江门529030

出　　处：《中国医药科学》2013年第12期215-216,共2页China Medicine And Pharmacy

基　　金：广东省卫生厅科学技术研究基金资助项目(WSTJJ201111 26152921197212040459)

摘　　要：目的探讨低血糖是否可导致危重症患者死亡率增高及中、重度低血糖的特点。方法回顾性研究了重症监护病房中5018例危重症患者中、重度低血糖(血糖分别是:41～70mg/dL[2.3～3.9mmol/L]和≤40mg/dL[2.2mmol/L])和死亡的关系。并分析了两种低血糖流行病学特点。结果随访数据表明5018例患者中:1222(24.4%)有中度低血糖,其中234例(19.1%)患者是在严格控制血糖组,86例患者(1.8%)有重度低血糖,其中39例(45.3%)是在严格控制血糖组,3690例(73.5%)患者无低血糖,612(16.6%)例死亡,对比1222例中度低血糖患者中339例死亡(27.7%),86例重度低血糖患者中42人死亡(48.8%)。低血糖患者死亡率(28.7%)高于无低血糖患者(16.6%)(P<0.05),重度低血糖组死亡率(48.8%)高于中度低血糖组(27.7%)(P<0.05);重度低血糖组APACHEⅡ评分、ICU住院时间明显高于中度低血糖组(P均<0.05)。结论低血糖在临床发病率仍然很高,可提高危重症患者的死亡率,并且随低血糖程度的加深,死亡率也增高,应在临床予以重视。Objective To analyze whether hypoglycemia leads to a increase of death in critically ill patients and retrospectively the clinic characters of moderate and severe hypoglycemia. Methods We retrospectively examined the associations between moderate and severe hypoglycemia （blood glucose,41 to 70 mg per deciliter [2.3 to 3.9 mmol per liter] and 〈 40 mg per deciliter [2.2 mmol per liter],respectively） and death among 5018 critically ill patients in intensive care units （ICUs）. And the clinic characters of moderate and severe hypoglycemia. Results Follow-up data were available for 3018 patients：1222（24.4%） had moderate hypoglycemia, 234 of whom（19.1%）were in the intensive- control group,and 86 patients （1.8%） had severe hypoglycemia,39 of whom（45.3%） were in the intensive-control group. Of the 3690 patients （73.5%）who did not have hypoglycemia,612（16.6%） died,as compared with 339 of the 1222 with moderate hypoglycemia （27.7%） and 49 of the 86 with severe hypoglycemia 48.8%）. The mortality of patients with hypoglycemia was higher than in patients without hypoglycemia,severe hypoglycemia was higher than moderate（all P 〈 0.05）. The APACHE 1/ score and length of stay in ICU in severe hypoglycemia group were higher than in m6derate hypoglycemia group（P 〈 0.05）. Conclusion The incidences of hypoglycemia is still high,more severe hyperglycemia is associated with higher morbidity and mortality.

关 键 词：低血糖 预后 严格血糖控制 

分 类 号：R587.3[医药卫生—内分泌]