程序化血糖管理模式对脓毒症合并糖尿病患者血糖水平控制及预后的影响  

Effect of programmed blood glucose management model on blood glucose control and prognosis in patients with sepsis and diabetes mellitus

作　　者：范良梅 杨杰[1] 赵荣美 吴芬 Fan Liangmei;Yang Jie;Zhao Rongmei;Wu Fen(Department of Infectious Disease,Lishui Central Hospital,the Fifth Hospital Affiliated to Wenzhou Medical University,Lishui 323000,Zhejiang Province,China)

机构地区：[1]温州医科大学附属第五医院、丽水市中心医院感染科,丽水323000

出　　处：《中国基层医药》2024年第9期1352-1357,共6页Chinese Journal of Primary Medicine and Pharmacy

基　　金：浙江省医药卫生科技计划(2020ZH013)。

摘　　要：目的探讨程序化血糖管理模式对脓毒症合并糖尿病患者血糖水平控制情况及预后的影响。方法收集2021年1月至2023年10月在温州医科大学附属第五医院(丽水市中心医院)就诊的脓毒症合并糖尿病患者76例的临床资料,按照程序化血糖管理模式实施时间前后,将2021年1月至2022年12月实施常规护理的37例患者设为常规组,将2023年1—10月在常规护理基础上联合程序化血糖管理模式的39例患者设为试验组。比较两组患者感染科住院时间、28 d病死率、血糖控制水平(感染科住院期间糖化血红蛋白水平、血糖变异度、低血糖发生率,空腹及餐后2 h血糖)、健康状况[美国简明健康测量量表(MOS-SF36)]以及不良事件发生情况。结果试验组患者感染科住院时间(14.85±2.77)d,短于常规组的(17.42±3.24)d(t=3.72,P<0.001);试验组患者28 d病死率为7.69%(3/39),低于常规组的24.32%(9/37)(χ^(2)=3.95,P=0.047);试验组患者感染科住院期间糖化血红蛋白水平[10.4,(8.5,12.1)mmol/L]、血糖变异度[(31.54±7.16)%]均低于常规组[12.8(8.9,15.3)mmol/L、(45.63±12.19)%](Z=6.88,P<0.001;t=6.18,P<0.001);试验组患者低血糖发生率为10.81%(4/37),与常规组的5.13%(2/39)比较,差异无统计学意义(χ^(2)=0.84,P=0.358);干预后试验组患者MOS-SF36限制维度[(72.21±5.37)分、机体疼痛维度[(82.98±6.41)分]、总体健康维度[(81.32±6.23)分]、躯体功能维度[(71.43±5.22)分]均高于常规组的(68.39±6.21)分、(78.35±6.17)分、(74.50±7.57)分、(65.57±6.96)分(t=2.87,P=0.005;t=3.20,P=0.002;t=4.29,P<0.001;t=4.16,P<0.001);试验组患者不良事件发生率为10.26%(4/39),与常规组的13.51%(5/37)比较,差异无统计学意义(χ^(2)=0.19,P=0.660)。结论程序化血糖管理模式可提高脓毒症合并糖尿病患者血糖水平控制水平,并改善患者预后。Objective To investigate the effect of programmed blood glucose management model on blood glucose control and prognosis in patients with sepsis and diabetes mellitus.Methods Seventy-six patients with sepsis and diabetes mellitus who received treatment at the Fifth Hospital Affiliated to Wenzhou Medical University(Lishui Central Hospital)were included in this study.According to the implementation time of programmed blood glucose management model,the patients were divided into a routine group(n=37;receiving routine nursing between January 2021 and December 2022)and an experimental group(n=39,receiving routine nursing and programmed blood glucose management).Length of hospital stay,28-day mortality rate,blood glucose control level(glycosylated hemoglobin level,blood glucose variability,incidence of hypoglycemia,fasting blood glucose level,and 2-hour postprandial glucose level),and health status(Medical Outcomes Study-36-Item Shot-Form Health Status Survey)as well as incidence of adverse events were compared between the two groups.Results The length of hospital stay in the experimental group was(14.85±2.77)days,which was significantly shorter than that in the routine group[(17.42±3.24)days,t=3.72,P<0.001].The 28-day mortality rate in the experimental group was 7.69%(3/39),which was significantly lower than that in the control group[24.32%(9/37),χ^(2)=3.95,P=0.047].The level of glycated hemoglobin and blood glucose variability in the experimental group were 10.4(8.5,12.1)mmol/L and(31.54±7.16)%,which were significantly lower than those in the routine group[12.8(8.9,15.3)mmol/L,(45.63±12.19)%,Z=6.88,P<0.001;t=6.18,P<0.001].There was no significant difference in the incidence of hypoglycemia between the experimental and routine groups[10.81%(4/37)vs.5.13%(2/39),χ^(2)=0.84,P=0.358].After the intervention,the experimental group had higher scores in various dimensions of the 36-Item Shot-Form Health Status Survey,including limitations[(72.21±5.37)points],bodily pain[(82.98±6.41)points],general health[(81.32±6.23)p

关 键 词：脓毒症 糖尿病 血糖 糖蛋白类 低血糖症 预后 死亡率 

分 类 号：R473[医药卫生—护理学]