血糖波动对危重颅脑疾病患者预后影响的相关性研究
发布时间：2019-04-08 08:08
【摘要】：背景与目的： 应激性血糖升高是ICU危重患者中普遍存在的一种现象[1,2]，过高的血糖可能导致多器官功能的损害。高血糖对机体的损害主要由两种方式来表现，一是持续性的高血糖，二是较大的血糖波动幅度（也称血糖变异度）。国内外已经有相关的研究指出，较大的血糖波动比持续高血糖对糖尿病的慢性并发症有更大影响。并且血糖波动和高血糖状态相互促进，相辅相成，共同对患者的预后产生影响。但对于危重颅脑疾病患者，血糖波动是否和其预后相关，，血糖波动能否成为影响危重颅脑疾病患者预后的独立危险因素，目前尚缺乏系统性临床观察。本文通过对80例新入苏大附一院急诊科ICU以及江苏省靖江市人民医院集团重症医学科的危重颅脑疾病患者进行72小时的血糖监测，计算其血糖波动指标，并对患者的28天预后进行观察，探讨血糖波动和其预后的相关性，以便早期判断疾病的危重程度，并为此类患者的早期临床治疗提供理论依据。 研究方法： 研究对象选择2012年09月至2013年07月入住苏大附一院急诊科重症监护病房（ICU）以及江苏省靖江市人民医院集团ICU，当日急性生理学与慢性健康状况评分系统Ⅱ（APACHE-Ⅱ评分）≥15分，ICU住院时间≥3天，4分≤GCS≤8分的危重颅脑疾病患者进行血糖监测及预后观察，排除既往有糖尿病史，或合并有严重的其他脏器的损伤，或者伤前有饮酒史的患者，或者有高血压病史者，共80例，失访2例，余78例，其中男性42例，女性36例，平均年龄49.6±11.5岁。血糖监测终点为转入ICU后72小时，预后观察终点为转入ICU后28天；计算患者转入ICU时的平均血糖（GluAve）、血糖变异性指标[血糖标准差（GluSD)、血糖变异系数（GluCV）、第1、2、3天以及72小时的血糖不稳定指数（GLI-1、GLI-2、GLI-3、GLI-3d）]。按患者预后情况分为死亡组（n=38)及生存组(n=40)，比较两组间APACHE-Ⅱ评分、血糖变异性、炎症因子hs-CRP（超敏C反应蛋白）及肿瘤坏死因子α (TNF-α)水平、胰岛素抵抗指标、颅脑损伤程度特异性指标NSE（神经元特异性烯醇化酶）及28天病死率的差异。 研究结果： （1）死亡组APACHE-Ⅱ评分明显高于生存组[（23.8±6.5) vs (21.6±5.4)，Ρ0.05]，死亡组hs-CRP、TNF-α以及NSE均明显高于生存组(均Ρ0.05)；NSE与APACHE-Ⅱ评分显著相关（Ρ0.01）； （2）死亡组患者的血糖变异指标GluSD、GluCV、GL-1、GLI-3d及低血糖发生率均明显高于生存组（Ρ0.05），而GluAdm（初始血糖）、GluAve比较差异无统计学意义（均Ρ0.05）； （3）死亡组胰岛素抵抗指标HOMA-IR、HOMA-β、胰岛素总用量与生存组比较差异有统计学意义(Ρ0.05)，且GLI-3d与HOMA-IR及hs-CRP、TNF-α均显著相关（Ρ0.01）； （4）对反映预后的ROC曲线下面积进行比较，GLI-3d的AUC=0.901，对预后诊断有较高的准确性。 研究结论： 危重颅脑疾病患者的血糖波动与28天死亡率密切相关，控制血糖波动，保持血糖稳定比控制高血糖更重要。
[Abstract]:Background & objective: stress hyperglycemia is a common phenomenon in critically ill patients with ICU [1,2]. Hyperglycemia may lead to damage to multiple organ functions. There are two main ways to show the damage of hyperglycemia to the body. One is persistent hyperglycemia and the other is the larger fluctuation of blood sugar (also known as blood glucose variation). It has been pointed out at home and abroad that large fluctuation of blood glucose has more effect on chronic complications of diabetes than persistent hyperglycemia. And blood glucose fluctuation and hyperglycemia promote each other, complement each other, and affect the prognosis of patients together. However, whether the blood glucose fluctuation is related to the prognosis and whether the blood glucose fluctuation can be an independent risk factor affecting the prognosis of critical craniocerebral disease patients is still lack of systematic clinical observation. Based on the 72-hour blood glucose monitoring of 80 newly admitted ICU patients in the emergency department of the first affiliated Hospital of Jiangsu Province and the critical craniocerebral diseases of Jingjiang people's Hospital Group in Jiangsu Province, the blood glucose fluctuation indexes were calculated. The 28-day prognosis of the patients was observed to explore the correlation between the fluctuation of blood glucose and the prognosis in order to judge the severity of the disease early and provide theoretical basis for the early clinical treatment of this kind of patients. Methods: the subjects were selected from September 2012 to July 2013 in the Emergency intensive Care Unit of the first affiliated Hospital of Jiangsu Province (ICU) and Jingjiang people's Hospital Group (ICU,), Jiangsu Province. Patients with critical craniocerebral diseases whose acute physiology and chronic health status score 鈪
本文编号：2454420
[Abstract]:Background & objective: stress hyperglycemia is a common phenomenon in critically ill patients with ICU [1,2]. Hyperglycemia may lead to damage to multiple organ functions. There are two main ways to show the damage of hyperglycemia to the body. One is persistent hyperglycemia and the other is the larger fluctuation of blood sugar (also known as blood glucose variation). It has been pointed out at home and abroad that large fluctuation of blood glucose has more effect on chronic complications of diabetes than persistent hyperglycemia. And blood glucose fluctuation and hyperglycemia promote each other, complement each other, and affect the prognosis of patients together. However, whether the blood glucose fluctuation is related to the prognosis and whether the blood glucose fluctuation can be an independent risk factor affecting the prognosis of critical craniocerebral disease patients is still lack of systematic clinical observation. Based on the 72-hour blood glucose monitoring of 80 newly admitted ICU patients in the emergency department of the first affiliated Hospital of Jiangsu Province and the critical craniocerebral diseases of Jingjiang people's Hospital Group in Jiangsu Province, the blood glucose fluctuation indexes were calculated. The 28-day prognosis of the patients was observed to explore the correlation between the fluctuation of blood glucose and the prognosis in order to judge the severity of the disease early and provide theoretical basis for the early clinical treatment of this kind of patients. Methods: the subjects were selected from September 2012 to July 2013 in the Emergency intensive Care Unit of the first affiliated Hospital of Jiangsu Province (ICU) and Jingjiang people's Hospital Group (ICU,), Jiangsu Province. Patients with critical craniocerebral diseases whose acute physiology and chronic health status score 鈪
本文编号：2454420
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