血糖相关指标与重症患者预后的相关性

发布时间：2018-01-06 09:37

  本文关键词：血糖相关指标与重症患者预后的相关性　出处：《贵州医科大学》2017年硕士论文　论文类型：学位论文

  更多相关文章： 血糖 平均血糖 血糖标准差 血糖变异系数 平均绝对血糖改变值 血糖不稳定指数 重症患者 预后

【摘要】：目的:分析探讨重症患者平均血糖及血糖波动性与预后的相关性,同时将平均血糖及血糖波动性控制在一个相对合理的范围,以指导重症患者血糖的合理控制。方法:本研究是一项观察性研究,选取2016年1月~2016年12月入住贵州医科大学重症医学科并符合本次研究纳入和排除标准的患者,根据不同的指标统计分析如下:其一,根据患者28d预后分成存活组和死亡组,比较两组患者一般临床资料及血糖相关指标的差异;其二,应用感受性曲线(ROC曲线)评价APACHE II评分与血糖相关指标对28d预后的价值;其三,统计反应血糖波动性的指标——血糖不稳定指数(GLI),根据GLI的四分位数(1.09、6.66、13.58、26.49、206.00)将患者分为四组,即G1组:GLI在0%~25%(1.09(mmol/L)2/h/d≤GLI≤6.66(mmol/L)2/h/d)区间,G2组:GLI在26%~50%(6.66(mmol/L)2/h/dGLI≤13.58(mmol/L)2/h/d)区间,G3组:GLI在51%~75%(13.58(mmol/L)2/h/dGLI≤26.49(mmol/L)2/h/d)区间,G4组:GLI在76%~100%(26.4(mmol/L)2/h/d9GLI≤206.00(mmol/L)2/h/d)区间,分别比较上述各组之间患者APACHE II评分、平均血糖(BGmean)、28d病死率、住ICU时间及呼吸机使用情况的差异;其四,以平均血糖7.8mmol/L、10.0mmol/L为界,将患者分成三组,即Q1组:BGmean10.0mmol/L,Q2组:7.8mmol/L≤BGmean≤10.0mmol/L,Q3组:BGmean7.8mmol/L,分别比较上述三组间患者28d病死率、一般临床资料及血糖波动指标的差异;其五,以BGmean的中位数(9.88mmol/L)为界,将BGmean分为高BGmean组(BGmean中位数)和低BGmean组(BGmean≤中位数),同时以GLI的中位数(13.58(mmol/L)2/h/d)为界,将GLI分为高GLI组(GLI中位数)和低GLI组(GLI≤中位数),联合上述两个指标,同时满足低BGmean、低GLI的病人记为低BGmean+低GLI组,同时满足高BGmean、低GLI的病人记为高BGmean+低GLI组,同时满足低BGmean、高GLI的病人记为低BGmean+高GLI组,同时满足高BGmean、高GLI的病人记为高BGmean+高GLI组,分别比较上述四组患者一般临床资料及短期病死率的差异。结果:(1)死亡组患者APACHE II评分、呼吸机使用时间、平均血糖(BGmean)、血糖不稳定指数(GLI)、血糖标准差(BGSD)、血糖变异系数(BGCV)、平均绝对血糖改变值(MAG)均较存活组高,差异均具有显著统计学意义(P0.05),两组患者年龄、ICU停留时间差异无显著统计学意义(P0.05)。(2)APACHE II评分、BGmean、BGSD、BGCV、GLI、MAG对重症患者28d病死率的判断价值,ROC曲线下面积依次为0.627、0.677、0.780、0.758、0.806、0.799;(3)根据所有患者GLI的四分位数将患者分为四组,结果显示G1组患者BGmean最低,G4组BGmean最高,差异有显著统计学意义(P0.05),四组患者ICU停留时间差异无显著统计学意义(P0.05),G4组患者呼吸机使用时间最长,其余三组差异无显著统计学意义(P0.05)。28d病死率G4组患者最高,G1组与G2组、G2组与G3组28d病死率差异无显著统计学意义(P0.05),G1组与G3组患者28d病死率差异有显著统计学意义(P0.05);(4)根据平均血糖7.8mmol/L、10.0mmol/L,将患者分为三组,Q1组与Q2组BGmean、BGSD、BGCV、GLI、MAG及呼吸机使用时间差异有显著统计学意义(P0.05),其余指标差异无显著统计学意义(P0.05);Q2组与Q3组BGmean差异有显著统计学意义(P0.05),其余指标差异无显著统计学意义(P0.05);Q1组与Q3组年龄、BGmean、BGSD、GLI、MAG、呼吸机使用时间差异有显著统计学意义(P0.05),其余指标差异无显著统计学意义(P0.05);(5)根据所有患者BGmean中位数(9.88mmol/L)及GLI中位数(13.58(mmol/L)2/h/d),将患者分为四组,低BGmean+高GLI组患者28d病死率较低BGmean+低GLI组患者高,差异有显著统计学意义(P0.05),高BGmean+高GLI组患者28d病死率较高BGmean+低GLI组患者病死率高,差异有显著统计学意义(P0.05),而低BGmean+低GLI组患者与高BGmean+高GLI组患者、低BGmean+高GLI组患者与高BGmean+高GLI组患者28d病死率差异无显著统计学意义(P0.05)。结论:血糖波动与重症患者预后相关,GLI在评估重症患者病情及预测短期预后的价值优于其他血糖波动指标;控制重症患者GLI可改善患者预后,将重症患者GLI控制在13.58(mmol/L)2/h/d以下可能是一个相对合理的水平;将重症患者血糖水平控制在7.8~10.0mmol/L可能是一个相对合理的范围;剧烈的血糖波动性对重症患者机体的伤害大于高血糖对机体的损害。
[Abstract]:Objective: to analyze the correlation between mean blood glucose and blood glucose in patients with severe volatility and prognosis, while the average blood glucose and blood glucose fluctuation control in a reasonable range, the reasonable control of blood glucose in patients with severe guidance. Methods: This study is an observational study, from January 2016 ~2016 year in December admitted to the Guizhou Medical University ICU the Division also met the inclusion and exclusion criteria of the study patients, according to different statistical analysis as follows: first, according to the prognosis of 28d patients were divided into survival group and death group, the difference between the two groups of patients with clinical data and blood related indicators; second, application of sensibility curve (ROC curve) value evaluation APACHE II score and blood glucose on prognosis of 28d; third, statistical response the glucose fluctuation index blood glucose instability index (GLI), according to GLI's four bit number (1.09,6.66,13.58,26 .49206.00) patients were divided into four groups: group G1: GLI in 0%~25% (1.09 (mmol/L) 2/h/d = GLI = 6.66 (mmol/L) 2/h/d) interval, group G2: GLI in 26%~50% (6.66 (mmol/L) 2/h/dGLI = 13.58 (mmol/L) 2/h/d) interval, group G3: GLI in 51%~75% (13.58 (mmol/L 2/h/) dGLI 26.49 (mmol/L) 2/h/d) interval, group G4: GLI in 76%~100% (26.4 (mmol/L) 2/h/d9GLI = 206 (mmol/L) 2/h/d) were compared between the groups of interval, patients with APACHE II score, mean blood glucose (BGmean), the mortality rate of 28d, differences ICU time and the use of ventilator; fourth the average blood glucose, 7.8mmol/L, 10.0mmol/L, the patients were divided into three groups: group Q1: BGmean10.0mmol/L, group Q2: 7.8mmol/L = BGmean = 10.0mmol/L, BGmean7.8mmol/L, Q3 group were compared between the three groups of patients with the mortality rate of 28d, the differences between general clinical data and blood glucose fluctuation index; fifth, to BGmean (median 9.88mmol/L) is bounded, 灏咮Gmean鍒嗕负楂楤Gmean缁，

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