摘要
目的 探讨不同级别APACHEⅡ评分危重患者的合理血糖控制范围.方法 选取ICU患者205例,入院即刻进行APACHEⅡ评分,查即刻静脉血糖,随后每1～2 h查一次静脉血糖.按APACHEⅡ评分分值从低到高分三组（A组、B组、C组）,每组再随机分为一般控制血糖组（Ⅰ组）和严格控制血糖组（Ⅱ组）,比较三组即刻血糖的平均值及血糖变异度,比较三组各亚组的抗生素使用时间、ICU时间、脓毒症发生率、MODS发生率、28天病死率.结果 B组的平均血糖值大于A组,C组的平均血糖值大于B组.但B组血糖变异性明显高于A组.C（Ⅱ）组的血糖变异性明显高于C（Ⅰ）.A（Ⅰ）组和A（Ⅱ）组抗生素使用时间、ICU时间、低血糖发生率、脓毒症发生率、MODS发生率、病死率比较差异均无统计学意义（P〉0.05）,B（Ⅰ）组的抗生素使用时间、ICU时间明显长于B（Ⅱ）组,脓毒症发生率也明显高于B（Ⅱ）组（P〈0.05）,B（Ⅱ）组的低血糖发生率明显高于B（Ⅰ）组（P〈0.05）.C（Ⅰ）组和C（Ⅱ）组抗生素使用时间、ICU时间、脓毒症发生率比较差异无统计学意义（P〉0.05）,而C（Ⅱ）组的MODS发生率、病死率、低血糖发生率高于C（Ⅰ）组（P〈0.05）.结论 对于APACHEⅡ评分低于20分的患者,严格控制血糖并不能获益.对于APACHEⅡ评分20～29分的患者,严格控制血糖可以获益.而对于APACHEⅡ评分大于29分的患者,严格控制血糖弊大于利.
Objective To study glucose control of patients with different APACHE Ⅱ scores in ICU department. Methods 205 patients were divided into three groups from low to high according to APCHE II scores （group A, group B and group C）. Every group was randomly divided into two sub groups （ group I and group Ⅱ ）. Group I was conventional therapeutic group and group Ⅱ was intensive insulin therapeutic group. APACHE Ⅱ scores and vein glucose levels were recorded immediately and vein glucose levels were recorded every one or two hours. Glucose level and glucose variability were compared in three groups. Time of using antibiotics, ICU stay, rate of sepsis, rate of MODS, mortality were compared in every sub group. Results Average glucose level in group B was higher the group A, and average glucose level in group C was higher than group B （ P 〈 0.05 ）. Glucose variability in group B was higher than that in group A, Glucose variability in group C （ Ⅱ ） was higher than that in group C （ I ） （P 〈 0.05）. Time of using antibiotics, ICU stay, rate of sepsis, rate of hypoglycemia, rate of MODS, mortality had no statistical significance between group A（ I ） and group A（ Ⅱ ） （P 〉0.05）. Time of using antibiotics and ICU stay in group B（I） was longer than that in group B（ Ⅱ ） （P 〈0.05）. Rate of sepsis in group B （ I ） was higher than group B （ Ⅱ ） （ P 〈 0.05 ）. Rate of hypoglycemia in group B（ Ⅱ ） was higher than group B（ I ） （P 〈 0.05 ）. Time of using antibiotics, ICU stay, rate of sepsis had no statistical significance between group C （ I ） and group C （ Ⅱ ） （ P 〉 0.05 ）. Rate of MODS, mortality and rate of hypoglycemia in group C （ Ⅱ ） were higher than those in group C （ I ） （P 〈 0.05）. Conclusion Patients whose APACHE I1 scores were lower than 20 get no benefit from controlling glucose tightly. Patients with APACHE Ⅱ score between 20 to 29 do get benefit from controlling glucose tightly. But it is more
出处
《中国急救医学》
CAS
CSCD
北大核心
2013年第10期921-924,共4页
Chinese Journal of Critical Care Medicine
基金
武汉市卫生局临床医学科研项目（武卫2010[42]号）
