不同组织灌注水平感染性休克患者的动态血糖监测效果  

The effects of continuous glucose monitoring used in septic shock patients with different tissue perfusion

作　　者：郭一峰 隆云 刘大为 孙红[2] 郭海凌 李尊柱 马玉芬[2] 韩伟[3] 郭爱敏[4] 

机构地区：[1]中国医学科学院北京协和医院重症医学科,北京100730 [2]中国医学科学院北京协和医院护理部,北京100730 [3]中国医学科学院基础医学研究所统计与流行病学教研室,北京100005 [4]中国医学科学院北京协和医学院护理学院,北京100144

出　　处：《中国中西医结合急救杂志》2017年第3期278-282,共5页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：国家临床重点专科建设项目（2011872）;卫生行业科研专项项目（201202011）

摘　　要：目的 比较不同组织灌注水平感染性休克患者组织间液葡萄糖和动脉血糖之间的一致性.方法 采用前瞻性观察性研究方法,选择2013年4月至12月中国医学科学院北京协和医院重症医学科收治的年龄〉18周岁的感染性休克患者61例.应用实时动态血糖监测系统（RTCGMS）和动脉血气分析仪测量患者的组织间液葡萄糖和动脉血糖,通过国际标准化组织（ISO）标准和绝对差值相对数（RAD）的中位数计算两者之间的一致性.根据乳酸（Lac）和脉搏氧灌注指数（PI）,将感染性休克患者分为不同组织灌注水平,使用Bootstrap重抽样技术,比较不同组织灌注感染性休克患者组织间液葡萄糖和动脉血糖之间的一致性.结果 PI与Lac呈负相关（r=-0.272,P〈0.001）,两者反映机体组织灌注的相反变化趋势.Lac〉8 mmol/L患者组织间液葡萄糖与动脉血糖之间的一致性好于〉2~4 mmol/L者,ISO标准差值的95%可信区间（95%CI）为0.026~38.710（P〈0.05）.PI≤0.7%患者组织间液葡萄糖与动脉血糖之间一致性好于〉0.7%~1.4%者,RAD中位数差值的95%CI为0.002~0.076,ISO标准差值的95%CI为-27.000^-0.583（均P〈0.05）;PI〉3.0%患者组织间液葡萄糖与动脉血糖之间一致性好于PI≤0.7%、PI〉0.7%~1.4%和PI〉1.4%~3.0%患者,ISO标准差值的95%CI分别为3.322~28.302、11.988~40.265和5.170~33.333（均P〈0.05）.结论 当感染性休克患者处于组织低灌注时（Lac〉8 mmol/L或PI≤0.7%）,组织灌注越差,组织间液葡萄糖与动脉血糖之间一致性越好;当感染性休克患者处于正常局部组织灌注时（PI〉3.0%）,局部组织灌注越好,两者之间一致性越好.Objective To compare the consistency between interstitial fluid glucose and arterial blood glucose in septic shock patients with different tissue perfusion levels.Methods A prospective investigative study was conducted. Sixty-one septic shock patients with ages above 18 years old admitted to the Department of Critical Care Medicine of Peking Union Medical College Hospital, Chinese Academy of Medical Sciences from April 2013 to December 2013 were enrolled. The real-time continuous glucose monitoring system （RTCGMS） and arterial blood gas analyzer were used to measure the patients＇ interstitial fluid glucose and arterial blood glucose, and according to the criteria of International Organization for Standardization （ISO） and the median of relative absolute difference （Median RAD）, the consistency between interstitial fluid glucose and arterial blood glucose was calculated. Based on the lactate （Lac） level and pulse oxygen perfusion index （PI）, the septic shock patients were divided into groups with different degrees of tissue perfusion, the consistency between the interstitial fluid glucose and arterial blood glucose among septic shock patients with different degrees of tissue perfusion was compared by using Bootstrap re-sampling technique.Results Negative correlation existed between PI and Lac （r= -0.272,P 〈 0.001）, which showed the opposite change tendency of organism tissue perfusion. In patients with Lac 〉 8 mmol/L, their consistency between interstitial fluid glucose and arterial blood glucose was better than that in those with Lac 〉 2-4 mmol/L, and the 95% credibility intervals （CI） of ISO standardized deviation value was 0.026-38.710 （P 〈 0.05）. In patients with PI ≤ 0.7%, their consistency between interstitial fluid glucose and arterial blood glucose was better than that in those with PI 〉 0.7%-1.4%, the 95%CI of median RAD difference value was 0.002-0.076, and the 95%CI of ISO standardized deviation value was -27.000 to -0.583 （allP 〈 0.05）; in patients wi

关 键 词：休克 感染性 组织间液葡萄糖 动脉血糖 组织灌注 一致性 

分 类 号：R473.5[医药卫生—护理学]