血糖变异性对脓毒症28 d死亡率临床影响

目的：分析血糖变异性与不同程度脓毒症28 d死亡率间的关系．方法2010年9月至2012年9月入住急诊ICU时诊断为脓毒症，且至少在急诊ICU住院3 d以上的成年患者均入选，剔除达到排除标准的患者后，从剩余患者病历中提取血糖值及所需临床资料．计算每例患者的最高血糖、平均血糖及血糖标准差，根据患者脓毒症严重程度分组，统计学分析这些指标与28 d死亡率的关系．结果血糖标准差与28 d死亡率间有重要关联（OR＝4.237，＝0.021），脓毒症越严重，血糖变异性越大（＝0.016）．结论血糖变异性与脓毒症患者28 d死亡率独立相关，脓毒症严重程度与血糖变异性有积极相关性．

Impact of Glucose Variability on 28-Day Mortality in Patients with Sepsis

Objective The purpose of this study was to analyze the relation of blood glucose variability and 28-day mortality in patients with different degree sepsis. Methods From September 1, 2010 to September 30, 2012, all adult patients diagnosed with sepsis and treated at least 3 days in Emergency ICU （EICU） of the first affiliated hospital of Kunming Medical University were enrolled in the study. Then the blood glucose levels and the other requisite clinical data were obtained from historical electronic medical records of patients excluding the patients reached exclusive criteria. The maximum and mean of blood glucose, and the glucose variability （the standard deviation,SD of blood glucose） in each patient were calculated. The patients were assigned according to severity of sepsis, then the relationship between SD of blood glucose and 28-day mortality was statistically assessed. Results There was an important correlation between SD of blood glucose and 28-day mortality （OR=4.237, P=0.021） . The glucose variability increased with the serious of sepsis （ P= 0.016） . Conclusion Glucose variability is an independent predictor of 28-day mortality in septic patients. In addition, the severity of sepsis has a positive correlation with blood glucose variability.