标准血糖控制方案下血糖波动对神经外科重症患者预后的影响  

Effect of blood glucose fluctuation on prognosis in neurocritical ill patients under standard glycemic control

作　　者：李广罡[1] 孙玥[1] 米艳红[1] 常利平[1] 鞠洪艳[1] 徐如祥[1] 

机构地区：[1]北京军区总医院附属八一脑科医院ICU,北京100700

出　　处：《中华危重症医学杂志（电子版）》2014年第4期14-17,共4页Chinese Journal of Critical Care Medicine:Electronic Edition

基　　金：吴阶平医学基金会临床科研基金(320.6750.14023)

摘　　要：目的探讨在标准血糖控制方案下,神经外科重症患者血糖波动对预后的影响。方法选取72例入住神经外科重症监护病房的危重患者。根据患者28 d结局分为生存组（47例）和死亡组（25例）。利用动态血糖监测系统（CGMS）对所有患者血糖进行持续监测,并参照NICESUGAR网站公布的血糖控制方案进行血糖调控。比较两组患者的平均血糖水平,血糖不稳定指数（GLI）,平均血糖波动（MAGE）。利用ROC曲线分析各指标对患者预后的准确性,并采用单因素Logisitic回归分析其独立危险因素。结果两组间平均血糖差异无统计学意义（t=0.26,P=0.79）。死亡组患者GLI及MAGE水平均高于生存组（P均〈0.05）。ROC曲线下面积提示GLI预测患者预后的准确性较高（曲线下面积0.73,95%CI为0.57-0.91,P〈0.05）。单因素Logistic回归显示GLI是影响ICU患者预后的独立危险因素（OR=1.03,95%CI=1.01-1.05,P〈0.05）。结论在标准血糖控制方案背景下,神经外科危重症患者的病死率与血糖波动相关,血糖波动不仅提示病情严重程度,而且可引起机体内在的病理生理变化。Objective To discuss the effect of blood glucose fluctuation on the prognosis in neurocritical ill patients under the standard glycemic control. Methods A total of 72 neurocritical ill patients were divided into the survivor group （47 cases） and death group （25 cases） according to the 28-day survival result. All the patients were continuously monitored by glucose monitoring system, and controlled by the NICE-SURGAR study. The mean blood glucose, glucose liability （GLI） and mean amplitude of glycemic excursions （MAGE） were compared between the two groups. The ROC curve was used to estimate the veracity of above-mentioned indices on the prognosis in the ill patients, and the Logistic regression analysis was used to filtrate the independent risk factor. Results The mean blood glucose had no statistical differences between the two group （t = 0.26, P = 0.79）. The levels of GLI and MAGE in the death group were higher than those in the survivor group （all P 〈 0.05）. GLI had a better discrimination with the areas under the ROC curve of 0.73 （95%CI= 0.57-0.91, P〈 0.05）, and was an independent risk factor of prognosis （OR = 1.03, 95% CI = 1.01-1.05, P 〈 0.05）. Conclusions The glucose fluctuation is related to the mortality of neurocritical ill patients under the standard glycemic control. The glucose fluctuation not only suggests the illness severity, but also can cause a series of biological effects in critically ill patients.

关 键 词：重症监护 血糖 预后 

分 类 号：R459.7[医药卫生—急诊医学]