血糖波动对危重外伤患者生存状况影响的研究  

Research of the influence of daily sedation interruption on fluctuation of blood glucose level and mortality of critically ill trauma patients

作　　者：张颖萍[1] 秦龙[1] 

机构地区：[1]北京市海淀医院重症医学科,北京100080

出　　处：《临床和实验医学杂志》2015年第20期1689-1692,共4页Journal of Clinical and Experimental Medicine

基　　金：国家自然科学基金资助项目(项目编号:81273553)

摘　　要：目的研究血糖波动对危重外伤患者生存状况的影响。方法选取2012年12月到2014年2月入住急诊重症监护病房(ICU)的60例危重外伤患者为研究对象,观察并记录第一个24 h的血糖情况,每隔2 h检测一次,计算患者血糖的平均值(MEAN)、标准差(SD)、变异系数(CV)、血糖不稳定指数(GLI)、日最大血糖波动值(LAGE)以及28 d病死率。根据患者的MEAN和GLI的中位数把患者分为高MEAN+高GLI组(A组,6例),高MEAN+低GLI组(B组,10例),低MEAN+高GLI组(C组,12例),低MEAN+低GLI组(D组,32例),观察并比较各组患者的血糖变化水平及生存状况。结果四组患者的血糖变化指标差异均有统计学意义(P<0.05),血糖MEAN,C、D组较低,A、B组较高;血糖波动水平SD、CV、GLI、LAGE等B、D组较低,A、C组较高;APACHEⅡ评分D组最低,A组最高,差异均有统计学意义(P<0.05);高血糖发生率以A、B组较高,D组最低;低血糖发生率以A组最高,B、D组较低;差异均有统计学意义(P<0.05);四组患者ICU住院时间、28 d病死率差异有统计学意义(P<0.05),ICU入住时间D组时间最短,效果较好;28 d病死率D组最低,A组最高,总体死亡率为8.3%。结论较低血糖波动患者的高血糖和低血糖的发生率较低,同时患者的病死率的也较低。所以在临床治疗中应尽量降低患者的血糖波动,必要时可给予降糖治疗。Objective To explore the impact on survival of fluctuations in blood glucose in critically ill trauma patients. Methods 60 patients in critically ill trauma patients were selected between December 2012 and February 2014 in emergency intensive care unit. These patients were implemented daily sedation interruption. The first 24 h of blood sugar every 2 h were observed and recorded. The average of blood glucose（ MEAN）,standard deviation（ SD）,coefficient of variation（ CV）,glycemic instability index（ GLI）,the maximum daily fluctuations in blood glucose values（ LAGE） and 28 d mortality were calculated. According to the patient＇s MEAN and GLI median,the patients were divided into high MEAN ＋ high GLI group（ A,6 cases）,high MEAN ＋ low GLI group（ group B,10 patients）,low MEAN ＋ high GLI group（ group C,12 patients）,low MEAN ＋ low GLI group（ D group,32 cases）. The changes in blood sugar levels and survival of patients in each group were observed and compared. Results Blood glucose targets of four groups of patients were statistically significant（ P〈0. 05）,glucose MEAN,C,D group are lower,A,B group are higher. The fluctuations in blood sugar levels SD,CV,GLI,LAGE such as B,D group are lower,and A,C group are higher. The APACHEⅡ score in group D is lowest,group A is the highest,the difference was statistically significant（ P〈0. 05）.High incidence of hypoglycemia in A group,the group B is higher,the D group is lowest. The hypoglycemia rate in A group is the highest. B,D group is low; the differences were statistically significant（ P〈0. 05）. Four patients stay in ICU,28 d mortality difference was statistically significant（ P〈0. 05）. ICU stay time D group is shortest; 28 d fatality rate in group D is lowest. The overall mortality rate in A group is highest with8. 3%. Conclusion Lower incidence of low blood glucose fluctuations was observed in patients with high blood sugar and low blood sugar,while the prognosis of mortality is low. Therefore,patients should

关 键 词：危重外伤 血糖波动 生存状况 

分 类 号：R459.7[医药卫生—急诊医学]