重型颅脑损伤患者血糖波动幅度对其病情转归的影响

发布时间：2018-04-19 01:10

本文选题：重型颅脑损伤 + 血糖　；参考：《青海大学》2017年硕士论文

【摘要】：目的:血糖波动(GV)是重症患者死亡的独立危险因素,但血糖及GV的相关指标并未纳入重型颅脑损伤(s TBI)救治指南。故本研究力图分析s TBI患者的GV,探讨GV对其预后的影响。方法:选择2015年11月至2016年11月入住急诊重症监护病房(EICU)进行治疗的80例s TBI患者,所有患者均采用统一的血糖监测和调控方案,血糖监测的终点为转入EICU后72小时,预后观察的终点为转入EICU后28天。从病例中提取80例患者的血糖值及相关临床资料,计算每位患者的格拉斯哥昏迷评分(GCS评分)、急性生理学及慢性健康状况评估Ⅱ(APACHEⅡ评分)及血糖相关指标[血糖初始值(Glu Adm)、血糖平均值(Glu Ave)、血糖最大波动幅度(Glu MD)、血糖标准差(Glu SD)、血糖变异系数(Glu CV)、血糖不稳定指数(GLI)、低血糖的发生率]。探讨血糖相关指标对患者28天预后的影响,将有统计学差异的GV指标与APACHEII评分、28天死亡率做相关性分析,评估有统计学差异的GV指标对s TBI患者死亡的预测价值。结果:(1)比较死亡组和存活组患者基本临床资料:s TBI患者的年龄、性别差异无统计学意义(47.08±9.17 VS 50.17±9.16,52.4%VS 47.6%,P0.05)。(2)比较死亡组和存活组血糖相关指标:Glu Adm、Glu Ave、Glu MD、低血糖发生率差异无统计学意义(P0.05),但死亡组的低血糖发生率明显高于存活组(13.2%(5/38)VS 4.8%(2/42))。Glu SD、Glu CV、GLI差异有统计学意义(3.23±1.27 VS 2.34±1.27、0.38±0.11 VS 0.24±0.11、20.68(14.93,26.48)VS15.70(12.89,19.50),P0.05)。(3)比较s TBI不同损伤程度组患者GV指标:与中等重度组比,重度组、极重度组Glu SD、Glu CV、GLI高;与重度组比,极重度组Glu SD、Glu CV、GLI高,差异均有统计学意义(P0.05)。即s TBI损伤程度越重,GV越大。(4)上述有统计学差异的GV指标与APACHEII评分及28天死亡率的相关性分析:Glu SD、Glu CV、GLI与APACHEⅡ评分呈正相关(相关系数r/rs分别为0.666、0.668、6.273,P0.05),即血糖波动幅度越大,APACHEⅡ评分越高。Glu SD、Glu CV、GLI与s TBI患者28天死亡率呈正相关(相关系数rs分别为8.483、6.459、10.375,P0.05),即血糖波动幅度越大,s TBI患者死亡率越高。(5)Logistic回归分析有统计学差异GV指标对死亡的预测价值:Glu SD、Glu CV、GLI的ROC曲线下面积分别为0.774±0.055、0.772±0.256、0.824±0.049。三个GV指标均可以预测s TBI患者的死亡风险,但GLI是特异性最强的预后预测因子。结论:GV指标Glu SD、Glu CV、GLI与s TBI患者病情严重程度及预后相关;随着GV幅度的增加,患者预后越差;GLI是特异性最强的预后预测因子。
[Abstract]:Objective: blood glucose fluctuation (GV) were independent risk factors of death in patients with severe, but the related indexes of blood glucose and GV are not included in the severe traumatic brain injury (s TBI) guidelines. This research tries to analyze s TBI GV patients, to explore the effects of GV on the prognosis. Methods: from November 2015 to November 2016 in emergency intensive care ward (EICU) of 80 cases of s TBI patients, all patients were treated by blood glucose monitoring and control scheme of unified, the end point blood glucose monitoring for 72 hours after transfer to the EICU end point observation prognosis for 28 days after transferred to EICU. The extraction of 80 cases of patients with blood glucose and related clinical data from patients in each calculation patients with Glasgow coma score (GCS score), acute physiology and chronic health evaluation II (APACHE II) and related indicators of blood glucose blood glucose [initial value (Glu Adm), mean blood glucose (Glu Ave), the maximum amplitude of fluctuation of blood glucose (Glu MD), standard deviation of blood glucose (Glu SD), coefficient of variation of blood glucose (Glu CV), blood glucose instability index (GLI), rate. To investigate the related indicators of blood glucose in patients with 28 day prognosis of hypoglycemia, there will be GV index and APACHEII score difference, 28 day mortality rate correlation analysis evaluation of GV index, statistical difference on the predictive value of death s TBI patients. Results: (1) comparison of death and survival group s: basic clinical data of TBI patients' age, gender difference has no statistical significance (47.08 + 9.17 VS 50.17 + 9.16,52.4%VS 47.6%, P0.05). (2) and death group the survival group blood glucose related indicators: Glu Adm, Glu Ave, Glu MD, no significant differences in the incidence of hypoglycemia (P0.05), but the incidence of hypoglycemia in death group was significantly higher than the survival group (13.2% (5/38) VS 4.8% (2/42)).Glu SD, Glu CV, GLI difference was statistically significant (3.23 + 1.27 VS 2.34 + 1.27 0.11, 0.38 + VS 0.24 + 0.11,20.68 (14.93,26.48) VS15.70 (12.89,19.50), P0.05). (3) s TBI GV in patients with different degree of injury group and moderate severe group index: ratio of severe group, severe group Glu SD, Glu CV, GLI; and severe group than Glu group, severe SD Glu, CV, GLI, the differences were statistically significant (P0.05). S TBI more severe injury, the greater the GV. (4) the correlation analysis between GV index and APACHEII score had significant difference and 28 day mortality: Glu SD, Glu CV, GLI and APACHE II score was (correlation coefficient r/rs respectively 0.666,0.668,6.273, P0.05), the blood glucose fluctuation is large, the higher the score of APACHE.Glu SD, Glu CV, GLI s and TBI were related to the 28 day mortality rate (positive correlation coefficient RS is respectively 8.483,6.459,10.375, P0.05), the blood glucose fluctuation is large, the higher mortality rate in s patients with TBI (5). Logistic regression analysis with statistical difference The GV index of the predictive value of death: Glu SD, Glu CV, ROC area under the GLI curve were 0.774 + 0.055,0.772 + 0.256,0.824 + 0.049. three GV indicators can predict the risk of death in patients with TBI s, but GLI is the strongest predictors of specificity. Conclusion: GV index Glu SD, Glu CV. The severity of illness in patients with GLI s TBI and prognosis; with the increase of the amplitude of GV, patients with worse prognosis; GLI is the strongest predictors of specificity.

【学位授予单位】：青海大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R651.15

【相似文献】