摘要
目的探讨平均血糖和血糖变异对危重症患者预后的影响。方法回顾性分析252例入重症医学科(ICU)患者的病例资料,根据入ICU后30的预后分为死亡组(n=91)与存活组(n=161),比较两组间入ICU时的血糖(GluAdm)、平均血糖(GluAve)、血糖标准差(GluSD)、血糖变异系数(GluCV)的差异,并且应用受试者工作特征曲线(ROC曲线)评价APACHE II评分、GluSD、GluCV与危重症患者死亡的相关性。结果 252例患者中死亡91例,总病死率36.1%。死亡组患者APACHE II评分、GluSD及GluCV均明显高于存活组[APACHE II 29±8 vs.18±7,GluSD(2.98±0.96)mmol/L vs.(1.75±0.87)mmol/L,GluCV(0.34±0.09)vs.(0.23±0.12),P值均<0.05],而两组间GluAdm、GluAve没有统计学差异,P均>0.05。GluCV和APACHE II的ROC曲线下面积(AUC)分别为(0.72±0.06)和(0.75±0.04),二者无统计学差异(P>0.05),且二者高于GluSD的AUC(0.64±0.05)。结论危重症患者血糖波动与入ICU30d死亡的独立危险因素,控制血糖波动可能有利于改善预后。
Objective To investigate the association between blood glucose level fluctuation and prognosis of critically ill patients. Methods A retrospective study involving 252 critically ill patients in intensive care unit（ICU） was conducted. According to the 30-day outcome after admission to ICU, the patients were dirided into nonsurvivors （91 cases）and survivors（161）, monitored interms of their initial blood glucose（GluAdm）, the average blood glucose value（GluAve）, standard deviation of blood glucose（GluSD）, coefficient of variation glucose（GluCV）. Then GluCV were compared between survivors and nonsurvivors, and ROC curve was applied to evaluate the association between blood glucose level fluctuation and prognosis of critically ill patients. Result The 91 of 252 patients died with a mortality rate of 36.1%. the levels of APACHE II score , GluSD and GluCV of nonsurvivors were higher than those of survivors [APACHE II 29±8 vs. 18±7, GluSD （2.98±0.96） mmol/L vs. （1.75±0.87） retool/L, GluCV （0.34±0.09） vs. （0.23±0.12） , P〈0.05], but no difference in the levels of GluAdm and GluAve. When ROC was applied, and the area under the curve（AUC） of GIuCV and APACHE II were （0.72±0.06） and （0.75±0.04） , which was higher than that of GluSD. Conclusions Fluctuation of blood glucose is a significant independent risk factor of mortality in critically ill patients.Control the fluctuation of blood glucose concentration might improve the patients＇outcome.
出处
《中国医药指南》
2013年第21期1-2,共2页
Guide of China Medicine
基金
广东省卫生厅科学技术研究基金的资助(编号:WSTJJ20111126152921197212040459)
关键词
危重病
血糖变异
预后
血糖变异系数
Critical illness
Blood glucose fluctuatio
Prognosis
GIuCV
