应激高血糖和内科重症监护病房患者预后关系的探讨

目的探讨应激高血糖对内科重症监护病房（MICU）病人预后的影响。方法对入住武汉大学人民医院内科重症监护病房共1016例患者的资料进行回顾性分析。126例既往有糖尿病病史和890例无糖尿病病史的患者按入院时血糖分为组1（〈6mmol／L），组2（6mmol／L^-1），组3（8～10mmol／L），组4（〉10mmol／L）]，观察住院病死率，次要观察指标包括住院时间、住ICU时间、是否予以机械通气、抗生素、输血和血糖的治疗。结果既往无糖尿病患者病死率分别为组1（4．7％）、组2（12．1％）、组3（20．5％）、组4（30．3％），随着血糖的升高，无糖尿病组患者病死率增加；机械通气、输血、抗生素治疗的比例增高；住ICU时间延长。结论高血糖在内科重症监护病房患者中十分常见，是增加内科ICU患者死亡和预示预后差的一个重要因素。

Impact of stress hyperglycemia on prognosis of patients in medical intensive care unit

Objective To evaluate the association between stress hyperglycemia and clinical out-comes among patients with and without diabetes mellitns admitted to medical intensive care unit (MICU).Methods We reviewed the medical ICU records of 1016 consecutive patients admitted to Wu Han Univer-sity Ren Min Hospital. According to admission glucose level, 126 patients with debates and 890 patients without known debates were divided into group 1 ( <6 mmol/L), group 2(6 ～ 8mmol/L), group 3(8 ～10mmol/L), and group 4( > 10mmol/L). The primary end point of the study was in-hospital mortality. Secondary end points included length of hospital stay, length of ICU stay, the ratio of mechanical ventila-tion, blood transfusions, antibiotics and blood glucose treatment. Results The hospital mortality among patients without a history of diabetes mellitus was 4. 7%, 12. 1%, 20. 5%, 30. 3% in group 1, 2, 3, 4,respectively. The ratio of mechanical ventilation, blood transfusions, and antibiotics increased progressively as glucose values increased. Conclusions Hyperglycemia was a common disease, and it may be an impor-tant marker of poor clinical outcome and mortality in patients without history of diabetes.