应激性高血糖对ICU危重症患者感染的影响  

Influence of stress hyperglycemia on ICU patients with infections

作　　者：陈海燕[1] 邢红叶 方芳[1] 范蓓蓉 陈培服[1] CHEN Hai-yan;XING Hong-ye;FANG Fang;FAN Bei-rong;CHEN Pei-fu(Ningbo Second Hospital,Ningbo,Zhejiang 315010,China)

机构地区：[1]宁波市第二医院重症医学科,浙江宁波315010

出　　处：《中华医院感染学杂志》2018年第16期2481-2485,共5页Chinese Journal of Nosocomiology

基　　金：浙江省宁波市卫生科技基金资助项目(2017A22)

摘　　要：目的探讨应激性高血糖对ICU危重症患者感染的影响。方法回顾性分析2014年2月-2016年5月医院ICU住院的205例患者的临床资料,根据患者入住ICU期间空腹血糖水平分为A组55例、B组79例、C组71例。统计并比较三组患者入住ICU期间死亡率、感染发生率、多器官功能障碍综合征(MODS)发生率;统计并比较三组感染发生部位情况及三组送检标本中感染病原菌情况;比较三组呼吸系统感染患者经抗感染治疗前后血清炎症细胞因子水平。结果 A组、B组、C组感染率分别为23.64%、40.51%、59.15%,B组、C组感染率高于A组,C组感染率、MODS发生率高于B组(P<0.05);C组死亡率高于A组、B组(P<0.05);B组、C组呼吸系统感染构成比均高于A组,C组呼吸系统感染构成比高于B组(P<0.05);C组革兰阳性菌感染率高于A组,B组、C组革兰阴性菌感染率高于A组(P<0.05);经相应抗感染治疗后,三组患者血清PCT、CRP、TNF-α水平均低于治疗前(P<0.05);B、C组治疗后血清PCT、CRP、TNF-α水平高于A组(P<0.05);C组治疗后血清PCT、CRP、TNF-α水平高于B组(P<0.05)。结论 ICU应激性高血糖患者的血糖浓度越高,患者机体炎症水平越严重,感染率及死亡率越高,预后越差。OBJECTIVE To explore the influence of stress hyperglycemia on ICU patients with infections.METHODS The clinical data of 205 patients who were hospitalized in ICU from Feb 2014 to May 2016 were retrospectively analyzed,the enrolled patients were divided into the group A with 55 cases,the group B with 79 cases,and the group C with 71 cases according to the level of fasting blood glucose during the ICU stay.The mortality rate,incidence of infections and incidence of multiple organ dysfunction syndrome（MODS）were statistically analyzed and compared among the three groups of patients.The distribution of infection sites and isolation rates of pathogens in submitted specimens were observed and compared among the three groups of patients,and the levels of serum inflammatory cytokines were compared among the three groups of patients before and after the treatment of the infections.RESULTS The incidence of infection was 23.64% in the group A,40.51% in the group B,59.15%in the group C;the incidence of infection was significantly higher in the group B and the group C than in the group A;the incidence of infection and incidence of MODS were significantly higher in the grop C than in the group B（P〈0.05）.The mortality rate of the group C was significantly higher than that of the group A and the group B（P〈0.05）.The constituent ratio of the patients with respiratory system infection was significantly higher in the group B and the group C than in the group A,and the constituent ratio of the patients with respiratory system infection was significantly higher in the group C than in the group B（P〈0.05）.The incidence of gram-positive bacteria infection was significantly higher in the group C than in the group A;the incidence of gram-negative bacteria infection was significantly higher in the group B and the group C than in the group A（P〈0.05）.The levels of serum PCT,CRP and TNF-αof the three groups of patients were significantly lower after the treatment than before the treatment（P〈0.05）;the levels of

关 键 词：ICU 血糖 感染 炎症 细胞因子 预后 

分 类 号：R459.7[医药卫生—急诊医学]