危重症患者早期血糖波动与预后的相关性研究

目的探讨危重病患者早期血糖波动与预后的相关性。方法回顾性分析206例入住重症医学科(ICU)的危重症患者的临床资料,根据患者预后分为存活组138例和死亡组68例。比较两组入ICU时血糖(GluAdm)、入ICU 24 h内APACHEⅡ评分、平均血糖(GluMV)、血糖标准差(GluSD)、血糖变异系数(GluCV)及低血糖发生率。应用受试者工作曲线(ROC曲线)下面积(AUC)评价以上指标与ICU患者病死率的相关性。结果死亡组APACHEⅡ评分显著高于存活组(P0.01)。两组GluAdm和GluMV比较差异无统计学意义(均P0.05),但死亡组GluSD、GluCV及低血糖发生率明显高于存活组(均P0.05)。APACHEⅡ评分及GluCV的AUC分别为(0.738±0.024)和(0.716±0.043),两者比较差异无统计学意义(P0.05)。结论危重患者早期血糖波动是导致患者死亡的独立危险因素,控制早期血糖波动有利于改善患者预后。

The association between early blood glucose variability and prognosis in critically ill patients

[ Objective ] To explore the association of early blood glucose variability and prognosis in critically ill patients. [ Methods ] A retrospective study involving 206 critically ill patients in intensive care unit（ICU） was conducted. The patients were divided into survivors（138 cases） and nonsurvivors（68 cases） according to outcome. Blood glucose concentration at admission（GluAdm）, the APACHE Ⅱ score in 24 hours after admission, the mean blood glucose value（GluMV）, standard deviation of blood glucose（GluSD）, coefficient of variation of blood glucose（GluCV） and the incidence of hypoglycemia between both groups were compared. The receiver operating curve（ROC curve） was applied to evaluate the association between blood glucose variability and prognosis. [ Results ] The APACHE Ⅱ score in nonsurvivors was significantly higher than that in survivors（P〈0.01）. The GluAdm and GluMV showed no significant differences between both groups（both P〉0.05）, but GluSD, GluCV and incidence of hypoglycemia were significantly higher in nonsurvivors than survivors（all P〈0.05）. When ROC curve was plotted, APACHE Ⅱ score and GluCV was （0.738 ± 0.024） and （0.716 ± 0.043）, and there was no significant difference（P〉0.05）. [ Conclusion ] Early blood glucose variability is a significant independent risk of mortality in critically ill patients. Control the early fluctuation of blood glucose concentration might improve the outcome of patients.