不同血糖控制目标对危重患者短期并发症及预后的影响
发布时间：2019-01-16 01:06
【摘要】：目的:通过观察、对比不同血糖控制目标危重患者的短期并发症及预后,研究不同血糖控制目标对危重患者的影响。提高重症医学科(intensive care unit,ICU)医护人员对危重患者血糖的重视程度,强调血糖监测的重要性,为临床治疗提供依据。方法:1研究对象及分组保定市第二中心医院ICU2013年9月-2015年2月期间就诊的患者。入选标准:①入住ICU≥5d;②急性生理和慢性健康状况评价系统II(acute physiology and chronic health evaluation II,APACHE-II)评分≥8分;③随机血糖≥11.1mmol/L的患者。排除标准:有糖尿病史、长期服用糖皮质激素病史的患者。根据排除标准及符合入选标准的②③,共计纳入患者230例,采用前瞻性研究将患者随机分为两组,最终符合上述①②③入选标准的患者152例,A组76例,B组76例。采用快速血糖仪(罗氏罗康全活力型血糖仪)监测血糖。血糖仪与检验科生化方法检测结果定期进行比对,确保快速血糖监测的准确性。入选的两组患者分别给予0.9%氯化钠50ml+普通胰岛素50u微量注射泵静脉泵入控制血糖,在24~72小时内将血糖控制在两个不同的目标范围内,其中A组血糖控制目标为:6.0~7.7mmol/L,B组血糖控制目标为:7.8~10.0mmol/L。治疗过程中监测Q1~4小时的快速血糖值,并根据血糖变化情况,按照血糖控制方案调整监测血糖频率及普通胰岛素泵入速度,维持两组血糖监测目标。2监测参数统计患者年龄、APACHE-Ⅱ评分、入住ICU时间、发生感染并发症例数(肺部感染、导管相关的血流感染、导尿管相关的尿路感染)、发生低血糖并发症例数、ICU死亡例数。所有结果采用SPSS17.0软件建立数据库并进行统计分析,计量资料以均数±标准差(x±s)表示,两组对比采用t检查;计数资料用χ2检验,P0.05有统计学意义,表示二者差异显著。结果:1两组一般情况:A组76例,其中男性40例,女性36例,平均年龄71.43±12.80岁(21~93岁),入院24小时平均APACHE-Ⅱ评分16.95±7.94分(8~40分)。B组76例,其中男性43例,女性33例,平均年龄67.93±13.38岁(11~93岁),入院24小时平均APACHE-Ⅱ评分16.93±7.87分(8~51分)。两组患者的性别、年龄、危重程度均无统计学差异(P0.05,见Table 1)。2两组并发症:A组发生感染并发症10例,B组发生感染并发症13例,两组患者感染并发症的发生率无统计学差异(P0.05,见Table 2)。A组中肺部感染(hospital acqurired pneumonia,HAP)9例,其中呼吸机相关性肺炎(ventilator associated pneumonia,VAP)1例,导尿管相关的尿路感染(catheter associated urinary tract infection,CAUTI)1例;B组中肺部感染(hospital acqurired pneumonia,HAP)11例,导管相关的血流感染(catheter-related bloodstream infection,CRBSI)1例,导尿管相关的尿路感染(catheter associated urinary tract infection,CAUTI)1例(见Table 2.2)。A组发生低血糖并发症8例,B组发生低血糖并发症2例,两组患者低血糖并发症的发生率有统计学差异,A组低血糖并发症发生率10.52%,B组低血糖并发症发生率2.63%,A组的低血糖并发症发生率明显高于B组(P0.05,见Table 3)。3两组预后:A组患者ICU平均住院时间11.37±8.31天,B组患者ICU平均住院时间11.88±7.97天,两组患者ICU住院时间无统计学差异(P0.05,见Table 4)。A组ICU实际死亡20例,B组ICU实际死亡17例,两组患者ICU死亡率无统计学差异(P0.05,见Table 4)。结论:1危重患者血糖目标控制在7.8~10.0mmol/L,和6.0~7.7mmol/L相比较,可以改善患者低血糖并发症,但不改善感染的并发症。2危重患者血糖目标控制在7.8~10.0mmol/L,和6.0~7.7mmol/L相比较,不能缩短ICU住院时间和改善ICU生存率。
[Abstract]:Objective: To study the effect of different blood glucose control objectives on critical patients by observing the short-term complications and prognosis of critical patients with different blood glucose control objectives. To improve the importance of the medical staff of intensive care unit (ICU) to the blood sugar of critically ill patients, and to emphasize the importance of blood glucose monitoring and provide the basis for clinical treatment. Methods: 1 subject and the second central hospital, ICU13, September-February, 2015. Inclusion criteria: admitted to ICU for 5days; acute physiology and chronic health evaluation system II (APACHE-II) scored a score of 8; and a patient with a random blood glucose of 11. 1mmol/ L. Exclusion criteria: a history of diabetes and a long-term patient with a history of corticosteroids. According to the exclusion criteria and the criteria for inclusion, a total of 230 patients were included in the study, and the patients were randomly divided into two groups using a prospective study, in which 152 patients, 76 in group A and 76 in group B, were randomly divided into two groups. The blood glucose was monitored with a rapid meter (Roche's full-energy meter). The blood glucose meter is compared with the test result of the biochemical method of the laboratory to ensure the accuracy of the rapid blood glucose monitoring. The control of blood glucose was controlled within 24-72 hours. The control target of blood sugar in group A was: 6. 0-7. 7mmol/ L, and the control target of blood sugar in group B was 7. 8-10. 0mmol/ L. monitoring the rapid blood sugar level of Q1 to 4 hours in the treatment process, adjusting the monitoring blood glucose frequency and the normal insulin pump input speed according to the blood sugar control scheme according to the blood sugar change condition, maintaining the two groups of blood glucose monitoring targets, Number of complications of infection (pulmonary infection, catheter-related blood flow infection, urinary catheter-related urinary tract infection), number of complications with hypoglycaemia, number of ICU deaths. All the results were based on the SPSS17.0 software, and the statistical analysis was carried out. The mean standard deviation (x% s) was used for the measurement data, and t-test was used for the two groups. The count data was used for the second test, and the difference between the two groups was statistically significant, indicating that the difference was significant. Results: A group of 76 cases were divided into two groups, including 40 male and 36 female, with average age of 71. 43 and 12. 80 years (21 to 93 years). The average APACHE-鈪，
本文编号：2409293
[Abstract]:Objective: To study the effect of different blood glucose control objectives on critical patients by observing the short-term complications and prognosis of critical patients with different blood glucose control objectives. To improve the importance of the medical staff of intensive care unit (ICU) to the blood sugar of critically ill patients, and to emphasize the importance of blood glucose monitoring and provide the basis for clinical treatment. Methods: 1 subject and the second central hospital, ICU13, September-February, 2015. Inclusion criteria: admitted to ICU for 5days; acute physiology and chronic health evaluation system II (APACHE-II) scored a score of 8; and a patient with a random blood glucose of 11. 1mmol/ L. Exclusion criteria: a history of diabetes and a long-term patient with a history of corticosteroids. According to the exclusion criteria and the criteria for inclusion, a total of 230 patients were included in the study, and the patients were randomly divided into two groups using a prospective study, in which 152 patients, 76 in group A and 76 in group B, were randomly divided into two groups. The blood glucose was monitored with a rapid meter (Roche's full-energy meter). The blood glucose meter is compared with the test result of the biochemical method of the laboratory to ensure the accuracy of the rapid blood glucose monitoring. The control of blood glucose was controlled within 24-72 hours. The control target of blood sugar in group A was: 6. 0-7. 7mmol/ L, and the control target of blood sugar in group B was 7. 8-10. 0mmol/ L. monitoring the rapid blood sugar level of Q1 to 4 hours in the treatment process, adjusting the monitoring blood glucose frequency and the normal insulin pump input speed according to the blood sugar control scheme according to the blood sugar change condition, maintaining the two groups of blood glucose monitoring targets, Number of complications of infection (pulmonary infection, catheter-related blood flow infection, urinary catheter-related urinary tract infection), number of complications with hypoglycaemia, number of ICU deaths. All the results were based on the SPSS17.0 software, and the statistical analysis was carried out. The mean standard deviation (x% s) was used for the measurement data, and t-test was used for the two groups. The count data was used for the second test, and the difference between the two groups was statistically significant, indicating that the difference was significant. Results: A group of 76 cases were divided into two groups, including 40 male and 36 female, with average age of 71. 43 and 12. 80 years (21 to 93 years). The average APACHE-鈪，
本文编号：2409293
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