应激性高血糖对重症脑血管病患者预后的影响  

Effect of stress hyperglycemia on the prognosis in patients with severe cerebral vascular diseases

作　　者：柳学[1] 陈纯波[1] 叶珩[1] 曾文新[1] 吕波[1] 曾红科[1] 

机构地区：[1]广东省人民医院(广东省医学科学院)急危重症医学部,广东广州510080

出　　处：《中华危重病急救医学》2016年第4期359-363,共5页Chinese Critical Care Medicine

基　　金：广东省医学科学技术研究基金资助项目（A2014023）

摘　　要：目的探讨重症脑血管病患者合并应激性高血糖对预后的影响。方法采用回顾性研究方法，选择2013年12月至2015年6月人住广东省人民医院脑科重症加强治疗病房（ICU）经影像学确诊的416例重症脑血管病患者。根据随机血糖（RBG）、糖化血红蛋白（HbA1c）和糖尿病史将患者分为正常血糖组（RBG〈11．1 mmol／L，HbA1c〈0．065，无糖尿病史）、糖尿病组（RBG≥11．1mmol／L，HbA1c≥0．065，有糖尿病史）和应激性高血糖组（RBG≥11．1mmol／L，HbA1c〈0．065，无糖尿病史）。比较3组患者院内感染发生率、ICU住院时间及28d病死率；采用Kaplan—Meier法进行生存曲线分析，多变量Cox危险比例模型估计死亡风险。结果416例患者中发生应激性高血糖40例，糖尿病患者46例，血糖正常330例；应激性高血糖总发生率为10．81％（40／370）。应激性高血糖组、糖尿病组患者院内感染发生率显著高于正常血糖组[55．00％（22／40）、52．17％（24／46）比18．79％（62／330），均P〈0．01]，ICU住院时间较正常血糖组明显延长（d：16．53±6．26、15．79±8．5l比9．23±4．29，均P〈0．01）；但应激性高血糖组与糖尿病组院内感染发生率和ICU住院时间比较差异无统计学意义（均P〉0．05）。应激性高血糖组28d病死率明显高于糖尿病组和正常血糖组[47．50％（19／40）比26．09％（12／46）、10．30％（34／330），P〈0．05和P〈0．01]。Kaplan—Meier生存分析显示，应激性高血糖组28d累积存活率较正常血糖组和糖尿病组明显下降（log-rank=6．148，P=0．043）。Cox危险比例模型分析显示，应激性高血糖是重症脑血管病患者死亡的危险因素[风险比（HR）=1．53，95％可信区间（95％CI）=1．04～1．26，P=0．001]。结论发生应激性高血糖的重症脑血管病患者28d病死率不仅显著高于血糖正常的患者，甚至显著高于有糖尿病史Objective To investigate the effects of stress hyperglycemia on prognosis in patients with severe cerebral vascular diseases. Methods A retrospective analysis was conducted. 416 patients with severe cerebral vascular diseases confirmed by radiological imaging admitted to intensive care unit （ICU） of Guangdong General Hospital from December 2013 to June 2015 were enrolled. According to the values of randomise blood glucose （RBG） and glycosylated hemoglobin （HbAlc） and diabetes history, the patients were divided into euglycemia group （RBG 〈 11.1 mmol/L, HbAlc 〈 0.065, without diabetes history）, diabetes group （RBG ≥ 11.1 mmol/L, HbA1c ≥ 0.065, with diabetes history）, and stress hyperglycemia group （RBG ≥ 11.1 mmol/L, HbA1c 〈 0.065, without diabetes history）. The nosocomial infection rate, the length of ICU stay and 28-day mortality were compared among the three groups. Survival analysis was performed using Kaplan-Meier method, and multivariate Cox proportional hazard model was used to estimate the risk of death. Results Among 416 patients, there were 40 cases with stress hyperglycemia, 46 with diabetes and 330 with euglycemia, with the incidence of stress hyperglycemia of 10.81% （40/370）. The nosocomial infection rates in the stress hyperglycemia group and diabetes group were significantly higher than those of the euglycemia group [55.00% （22/40）, 52.17% （24/46） vs. 18.79% （62/330）, both P 〈 0.01], and the length of ICU stay was significantly longer than that of the euglycemia group （days： 16.53 ± 6.26, 15.79 ± 8.51 vs. 9.23 ± 4.29, both P 〈 0.01）. No significant differences in nosocomial infection rate and length of ICU stay were found between stress hyperglycemia group and diabetes group （both P 〉 0.05）. The 28-day mortality rate in stress hyperglycemia group was significantly higher than that of diabetes group and euglycemia group [47.50% （19/40） vs. 26.09% （12/46）, 10.30% （34/330）,P 〈 0.05 and P 〈 0.01]. It was showed by Kapl

关 键 词：重症脑血管病 应激性高血糖 糖尿病 预后 

分 类 号：R587.1[医药卫生—内分泌] R743.3[医药卫生—内科学]