摘要
目的评估实时动态血糖监测对危重患者氧化应激及病死率的影响。方法人选的急重症患者分为实时动态血糖监测组（A组，61例）和血糖仪监测组（B组，62例），监测两组平均血糖漂移幅度（MAGE）、低血糖指数、高血糖指数、血浆8-异前列腺素F20L水平，记录两组患者28d病死率，并对上述指标进行相关分析。结果A组MAGE、低血糖持续时间[（2．42±0．27）h]、低血糖指数（0．0011）及高血糖指数（0．2258）均较B组下降[（5．90±0．67）h；0．0119；0．3697]。A组血浆8-异前列腺素F2α水平随时间推移较B组逐渐下降。血浆8-异前列腺素F2α水平与MAGE、低血糖指数、高血糖指数呈正相关。A组病死率（9．84％）较B组（30．65％）下降（X^2=8．22，P〈0．01）。结论实时动态血糖监测能有效改善危重患者的低血糖、高血糖、血糖变异及氧化应激，血糖控制、氧化应激的改善可降低患者病死率。
Objective To evaluate the effects of real-time continuous glucose monitoring （RT-CGM） system on oxidative stress and mortality in critically ill patients and to explore the correlation between glucose index, oxidative stress and mortality. Methods Selected 123 cases of critically ill patients were enrolled in this prospective randomized controlled study. They were randomly divided into the RT-CGM group（n = 61 ） and blood glucose meter group （GM group, n = 62）. The following parameters were compared between the two groups： mean amplitude of glucose excursions （MAGE）, hypoglycemia incidence, low blood glucose index （LBGI）, high blood glucose index （HBGI）, 28-day mortality and plasma level of 8-iso-PGF2α （8-iso） at 48 hours （ R2 ）, 72 hours （ R3 ） and 96 hours （ R4 ） after admission to ICU. The correlation between glucose index and plasma level of 8-iso-PGF2α were analyzed. The correlation between glucose index, plasma 8-iso level and 28-day death were analyzed. Results The parameters of MAGE, hypoglycemia incidence, LBGI and HBGI in the RT-CGM group and the GM group were （ 3.73 ± 1.09） mmoL/Land （4. 19±1. 11）mmol/L（P=0.02）, 3.28% and 14.52%（P=0.03）, 0.0011 and 0. O119 （ P 〈 0. 01 ） and 0. 2258 and 0. 3697 （ P 〈 O. 01 ）, respectively. The plasma levels of 8-iso at R2, R3, R4 in the RT-CGM group and the GM group were （ 111.44 ± 16. 99 ） ng/L and （ 114.03 ± 14. 64） ng/L （P=0.37）, （94.53 ±14.92）ng/L and （110.31 ± 13.42） ng/L（P 〈0.01） and （57.84 ±12.22） ng/L and （84. 41 ± 14. 16）ng/L（P 〈0. 01）, respectively. The r values between MAGE, LBGI, HBGI and the plasma level of 8-iso were 0. 69, 0. 71 and 0. 67, respectively （ all P values 〈 0. 01 ）. Multivariate stepwise regression analysis showed MAGE, LBGI, HBGI entered final models（ corrected R2 = 0. 61 ,P 〈 0. 01 ） with [3 values of O. 64, 0. 65 and 0. 6 respectively（all P values 〈0. 01 ）. The 28-day mortality in the RT-CGM group and the
出处
《中华内科杂志》
CAS
CSCD
北大核心
2013年第1期30-33,共4页
Chinese Journal of Internal Medicine
基金
国家临床重点专科建设项目
关键词
血糖
氧化性应激
危重病
死亡率
Blood glucose
Oxidative stress
Critical illness
Mortality
