摘要
目的从中医虚实辨证的角度探讨急性心力衰竭(心衰)患者的血糖控制策略.方法选择2017年6月至2018年6月杭州市第三人民医院重症监护病房(ICU)收治的96例急性心衰患者,剔除不符合标准的14例患者,最终纳入82例患者.按中医虚实辨证分型分为虚证组(52例)和实证组(30例),所有患者均接受至少4 d正规血糖监测和控制方案.记录两组患者4 d内血糖值、高血糖和低血糖发生率、每日胰岛素用量,并比较两组患者的医院感染(院感)发生率、ICU住院时间和28 d病死率.结果实证组的初始血糖值(mmol/L:10.56±3.12比8.09±2.57)、最高血糖值(mmol/L:15.47±3.16比11.28±3.85)、平均血糖值(mmol/L:9.52±2.08比7.29±1.50)均明显高于虚证组(均P<0.01).实证组高血糖发生率明显高于虚证组〔63.33%(19/30)比48.08%(25/52)〕,低血糖发生率则明显低于虚证组〔6.67%(2/30)比15.38%(8/52)〕,而实证组高血糖患者的每日胰岛素用量明显高于虚证组(U:55.35±6.68比18.58±7.10),差异均有统计学意义(均P<0.01).实证组28 d病死率明显高于虚证组〔20.00%(6/30)比11.54%(6/52),P<0.01〕,但两组间院感发生率〔13.33%(4/30)比15.38%(8/52)〕和ICU住院时间〔d:10.35±3.68比12.58±4.10〕差异均无统计学意义(均P>0.05).结论基于中医的虚实辨证的血糖控制策略可以降低虚证患者发生低血糖的风险,从而降低死亡风险;还可以提高实证患者血糖达标率,降低院感发生率,对于心衰患者具有临床意义,值得推广.
Objective To investigate the control strategy of blood glucose in patients with acute heart failure from the perspective of syndrome differentiation of deficiency from excess in traditional Chinese medicine(TCM).Methods Ninety-six patients with acute heart failure admitted to the intensive care unit(ICU)of Hangzhou Third People's Hospital from June 2017 to June 2018 were selected in the study.Fourteen patients who did not meet the standard criteria of inclusion were excluded,and 82 patients were finally enrolled.According to the syndrome type differentiation of TCM,the patients were divided into a deficiency group(52 cases)and a empirical or excess group(30 cases).All the patients received at least 4-day regular blood glucose monitoring and control programs.The blood glucose level,incidences of hyperglycemia and hypoglycemia,and average daily insulin dosages within 4 days in patients of the two groups were recorded,and the incidence of nosocomial infection,the time of stay in ICU and the 28-day mortality of the two groups were compared.Results The initial blood glucose value(mmol/L:10.56±3.12 vs.8.09±2.57),the highest blood glucose value(mmol/L:15.47±3.16 vs.11.28±3.85),and the average blood glucose value(mmol/L:9.52±2.08 vs.7.29±1.50)of the excess group were significantly higher than those of the deficiency group(all P<0.01).The incidence of hyperglycemia in the empirical syndrome group was significantly higher than that in the deficiency group[63.33%(19/30)vs.48.08%(25/52)],and the incidence of hypoglycemia was significantly lower than that in the deficiency group[6.67%(2/30)vs.15.38%(8/52)].In terms of daily insulin dosage,the insulin dose used in patients with hyperglycemia of excess group was significantly higher than that in patients of deficiency group(U:55.35±6.68 vs.18.58±7.10),the difference being statistically significant(all P<0.01).The 28-day mortality of the patients in empirical group after admission was significantly higher than that of the deficiency group[20.00%(6/30)vs.11.54%(6/52),P<0.
作者
潘金波
Pan Jinbo(Intensive Care Unit,Hangzhou Third People’s Hospital,Hangzhou 310009,Zhejiang,China)
出处
《中国中西医结合急救杂志》
CAS
CSCD
北大核心
2021年第2期159-162,共4页
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
基金
浙江省杭州市医药卫生科技项目(A20200205)。
关键词
中医学
辨证论治
心力衰竭
血糖
Traditional Chinese medicine
Syndrome differentiation and treatment
Heart failure
Blood glucose
