低血糖对重症患者预后影响的回顾性研究

发布时间：2018-02-24 09:41

本文关键词： 重症患者低血糖预后影响　出处：《华中科技大学》2013年硕士论文　论文类型：学位论文

【摘要】：目的：通过统计分析ICU重症患者低血糖发生情况和预后，评估低血糖发生对重症患者预后的影响。方法：选择2011年9月-2012年3月入住协和医院综合ICU进行治疗的199例重症患者，排除糖尿病酮症酸中毒及高血糖高渗性昏迷的病人，排除特殊照顾及政策照顾的病人，排除ICU期间血糖测量结果少于3次的病人，且同一病人再次入住ICU时视为一新病例。这期间患者的血糖控制策略为不严格血糖控制，目标血糖值是7.8-10mmol/l。记录每个患者的一般资料、ICU期间机械通气时间、ICU停留时间及转归（存活/死亡）、出院时间、入住ICU24h内的实验室检查结果、入住ICU期间的所有血糖测量值等，计算APACHEII评分及入住ICU期间的血糖最大值、平均血糖值、血糖标准差、血糖变异系数、每天测量次数、低血糖发生情况及发生时间等。根据患者入住ICU期间是否出现低血糖（血糖3.9mmol/l一次或多次）将其分为低血糖组和对照组，比较两组的预后指标有无统计学差异。结果：入住ICU的199例病人中，有35人发生至少一次低血糖（血糖3.9mmol/l），低血糖发生率为12.59%。低血糖组的35人中ICU死亡率是26.5%，与对照组相比（7.3%）有显著差异（P0.05）；ICU停留时间和机械通气时间，低血糖组也显著长于对照组（P0.05）。两组的年龄、性别、糖尿病史、机械通气、胰岛素应用率，无统计学差异（P0.05）；但APACHEII评分、平均血糖值、血糖变异系数、入科诊断、入科方式两组间有统计学差异。分别按这些因素分层分析后，低血糖组的ICU死亡率仍然高于对照组。与对照比较低血糖组的相对死亡风险（RR）是1.260（95%置信区间是1.026-1.549）。结论：ICU病人低血糖发生与死亡风险增加明显相关，即便是不进行严格血糖控制的患者发生轻中度低血糖也会使患者死亡率增加。因此对ICU患者应采取积极治疗措施来降低其低血糖的发生率。
[Abstract]:Objective: to evaluate the influence of hypoglycemia on the prognosis of severe ICU patients by statistical analysis of hypoglycemia and prognosis. Methods: from September 2011 to March 2012, 199 cases of severe patients admitted to Union Hospital with ICU were selected to exclude the patients with diabetic ketoacidosis and hyperglycemia hyperosmotic coma, and the patients with special care and policy care. Patients whose blood glucose measurements were less than three times during ICU were excluded, and the same patient was treated as a new case when they were admitted to ICU again. The blood glucose control strategy of the patients during this period was not strict blood glucose control. The target blood glucose value was 7.8-10 mmol / L. record the general data of each patient during mechanical ventilation, the duration of stay and outcome (survival / death, discharge time, laboratory examination results in ICU24h, all blood glucose measurements during ICU, etc.). Calculate the APACHEII score, the maximum of blood sugar, the average blood sugar value, the standard deviation of blood sugar, the coefficient of variation of blood sugar, the times of measurement every day, According to whether hypoglycemia (3. 9 mmol / l, once or more times) occurred during ICU, the patients were divided into hypoglycemia group and control group, and the prognostic indexes of the two groups were compared. Results: among the 199 patients admitted to ICU, 35 had hypoglycemia at least once (blood glucose 3.9 mmol / L, hypoglycemia incidence 12.59. The mortality rate of ICU was 26.5% in the hypoglycemia group, compared with the control group (7.3%).) there was a significant difference in the duration of stay and mechanical ventilation between 35 patients with hypoglycemia group and the control group. The age, sex, history of diabetes, mechanical ventilation and insulin application rate in the hypoglycemia group were also significantly longer than those in the control group (P 0.05), but there was no significant difference between the two groups (P 0.05), but APACHEII score, mean blood glucose value, coefficient of variation of blood glucose, diagnosis of the disease were not statistically significant. The mortality rate of ICU in hypoglycemia group was still higher than that in control group, and the relative death risk of hypoglycemia group was 1.260% 95% confidence interval of 1.026-1.549. Conclusion hypoglycemia is associated with an increased risk of death in ICU patients. Even mild to moderate hypoglycemia in patients without strict glycemic control can lead to an increase in mortality. Therefore, active treatment should be taken to reduce the incidence of hypoglycemia in patients with ICU.
【学位授予单位】：华中科技大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R459.7

【共引文献】