血糖水平及血糖变异度对ICU成年急性呼吸衰竭患者预后的影响  

Effects of 24-hour intravenous glucose level and variability on the prognosis of adult patients with acute respiratory failure in intensive care unit

作　　者：李佳媚[1] 高雅[1] 张静静[1] 李若寒 金旭婷 张小玲[1] 王小闯[1] 王岗[1] Li Jia-mei;Gao Ya;Zhang Jing-jing;Li Ruo-han;Jin Xu-ting;Zhang Xiao-ling;Wang Xiao-chuang;Wang Gang(Department of Critical Care Medicine,the Second Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710004,China)

机构地区：[1]西安交通大学第二附属医院重症医学科,陕西西安710004

出　　处：《中国急救医学》2021年第3期196-200,共5页Chinese Journal of Critical Care Medicine

基　　金：国家自然科学基金(81770057,81670049);陕西省重点研发计划项目(2017SF-059)。

摘　　要：目的探讨重症监护室(ICU)成年急性呼吸衰竭(acute respiratory failure,ARF)患者入ICU 24 h内静脉血糖水平及血糖变异度对患者医院病死率的影响。方法采用回顾性队列研究,纳入ICU多参数智能监护数据库Ⅱ(multiparameter intelligent monitoring in intensive careⅡ,MIMIC-Ⅱ)中单次入ICU且患有ARF,同时入住ICU后初始24 h内有多次静脉血糖监测记录的患者。提取患者的年龄、性别、种族、首次序贯器官衰竭评分、使用注射用胰岛素及患病情况(糖尿病、心力衰竭、肾衰竭及感染)。将入ICU 24 h内静脉血糖均值及血糖变异系数分别用来评估血糖水平及变异度,使用单因素及多因素Logistic回归分析评估血糖水平及血糖变异度与患者医院病死率之间的关系。并在血糖水平及血糖变异度与是否患糖尿病间分别进行交互作用分析。结果本研究共纳入1625例患者。从24 h内平均静脉血糖指标分析,低、中、高血糖水平患者的医院病死率分别为31.6%(171例)、35.4%(192例)及43.7%(237例),高血糖水平患者的医院病死率是低血糖水平患者的1.594倍(OR=1.594,95%CI 1.206~2.105);从24 h内血糖变异系数分析,低、中、高血糖变异患者的医院病死率分别为30.7%(166例)、38.0%(206例)及42.1%(228例),高血糖变异患者的医院病死率是低血糖变异患者的1.362倍(OR=1.362,95%CI1.035~1.792)。血糖水平(Pinteraction=0.178)及血糖变异度(Pinteraction=0.119)对医院病死率的影响在糖尿病患者与非糖尿病患者两组间比较差异无统计学意义(P <0.05)。结论 ARF患者入ICU 24 h内高血糖水平及高血糖变异度是其医院病死率的危险因素。Objective To explore the effect of 24-hour intravenous glucose level and its variability on hospital mortality in adult critically ill patients with acute respiratory failure( ARF).Methods All adult patients with ARF and multiple intravenous glucose monitoring records within the first 24 hours after admitting to the intensive care unit( ICU) were enrolled from the multiparameter intelligent monitoring in intensive care II database. The patients’ information including age,sex,ethnicity,the first sequential organ failure assessment score after ICU admission,the use of insulin,and admission diagnosis( diabetes mellitus,heart failure,renal failure and infection) were extracted. Mean value and variation coefficient of 24-hour intravenous glucose in ICU were used to evaluate the blood glucose level and its variation,respectively. Univariate and multivariate Logistic regression were used to evaluate the impact of glucose level and glucose variability on hospital mortality. The interaction of glucose level and glucose variability with diabetes mellitus were analyzed,respectively. Results A total of 1625 patients were enrolled in this study. In respect of mean glucose level,the hospital mortality of patients with low,moderate and high glucose levels was 31. 6%( 171 cases),35. 4%( 192 cases) and43. 7%( 237 cases),respectively. The hospital mortality of patients with high glucose level was 1. 594 times than those with low blood glucose level( OR = 1. 594,95% CI 1. 206-2. 105). In respect of glucose variability,the hospital mortality of patients with low,moderate and high glucose variability was30. 7%( 166 cases),38. 0%( 206 cases) and 42. 1%( 228 cases),respectively. The hospital mortality of patients with high glucose variability was 1. 362 times than those with low glucose variability( OR = 1. 362,95% CI 1. 035-1. 792). The influence of glucose level( Pinteraction = 0. 178) and glucose variability( Pinteraction = 0. 119) on hospital mortality were not significantly different between diabetic patients and non-diabetic pa

关 键 词：重症监护室(ICU) 急性呼吸衰竭(ARF) 血糖水平 血糖变异度 医院病死率 

分 类 号：R563.8[医药卫生—呼吸系统]