脓毒血症患者血糖与预后的关系  

Correlation between blood glucose in septicopyemia patients and their prognosis

作　　者：曾建琼[1] 王桂萍[1] 程青虹[1] 

机构地区：[1]石河子大学医学院第一附属医院重症监护室,新疆石河子832000

出　　处：《检验医学》2016年第2期95-98,共4页Laboratory Medicine

摘　　要：目的分析脓毒血症患者血糖水平与预后的关系。方法回顾性分析118例脓毒血症患者病史资料,根据患者使用胰岛素控制后的血糖水平分为血糖正常组（血糖浓度为4.0~6.1 mmol/L）、血糖轻度升高组（6.2~8.3 mmol/L）和血糖明显升高组（8.4~10.0 mmol/L）。比较3组之间糖化血红蛋白（Hb A1c）、多脏器功能障碍综合征（MODS）发生率、重症监护室（ICU）住院天数、抗菌药物使用时间、呼吸机使用时间、死亡率和急性生理学及慢性健康评分（APACHEⅡ）。结果血糖明显升高组MODS发生率（40.4%）、ICU住院天数[（14.15±1.40）d]、抗菌药物使用时间[（11.79±1.76）d]、呼吸机使用时间[（8.36±1.07）d]、死亡率（44.7%）及APACHEⅡ（22.26±1.75）均明显高于血糖轻度升高组[18.2%、（7.67±2.01）d、（7.97±1.45）d、（5.73±1.10）d、21.2%、14.94±1.48]和血糖正常组[13.9%、（7.29±1.74）d、（6.05±2.01）d、（5.11±0.98）d、15.8%、13.63±1.17]（P均〈0.01）。血糖轻度升高组抗菌药物使用时间、呼吸机使用天数、APACHEⅡ均明显高于血糖正常组（P均〈0.01）,而ICU住院天数、MODS发生率、死亡率2个组之间差异均无统计学意义（P均〉0.05）。3组之间Hb A1c水平差异无统计学意义（P〉0.05）。结论脓毒血症患者采用胰岛素控制血糖后如血糖仍升高,提示病情严重,且死亡率也随着血糖水平的升高而升高。早期严格监测血糖,有利于改善脓毒血症患者的预后。Objective To investigate the correlation between septicopyemia patients＇ blood glucose levels and their prognosis. Methods A total of 118 septicopyemia patients were enrolled,and their results were analyzed retrospectively. According to the blood glucose levels after controlling by insulin,the patients were classified into 3 groups, normal blood glucose group（4.0-6.1 mmol/L）,mildly high blood glucose group（6.2-8.3 mmol/L） and high blood glucose group（8.4-10.0 mmol/L）. The differences of glycated hemoglobin A1c（Hb A1c）,multiple organ dysfunction syndrome（MODS） incidence rate,intensive care unit（ICU） staying day,antibiotic usage time,ventilation usage time,the number of deaths and acute physiology and chronic health evaluation Ⅱ（APACHE Ⅱ）score among the 3 groups were analyzed. Results The incidence rate of MODS（40.4%）,ICU staying day [（14.15 ±1.40）d],antibiotic usage time [（11.79 ± 1.76）d],ventilation usage time [（8.36 ± 1.07）d],the mortality rate（44.7%）and APACHE Ⅱ score（22.26 ± 1.75）in high blood glucose group were much higher than those in mildly high blood glucose group [18.2%,（7.67±2.01）d,（7.97±1.45）d,（5.73±1.10）d,21.2% and 14.94±1.48] and normal blood glucose group [13.9%,（7.29±1.74）d,（6.05±2.01）d,（5.11±0.98）d,15.8% and 13.63±1.17]（P〈0.01）. The antibiotic usage time,ventilation usage time and APACHE Ⅱ score in mildly high blood glucose group were significantly higher than those in normal blood glucose group（P〈0.05）. However,there was no statistical significance for ICU staying day,MODS incidence rate and mortality rate between the 2 groups（P〉0.05）. There was no statistical significance for Hb A1 c among the 3 groups（P〉0.01）. Conclusions Septicopyemia patients with increasing blood glucose levels after controlling by insulin may suffer with a serious illness and poor prognosis. With increasing blood glucose levels,the mortality rate of patients may elevate. The control of blood glucose leve

关 键 词：脓毒血症 血糖 预后 多脏器功能障碍综合征 

分 类 号：R446.1[医药卫生—诊断学]