中国危重病急救医学
中國危重病急救醫學
중국위중병급구의학
CHINESE CRITICAL CARE MEDICINE
2012年
1期
24-28
,共5页
左艳艳%康焰%王波%尹万红
左豔豔%康燄%王波%尹萬紅
좌염염%강염%왕파%윤만홍
胰腺炎,急性%血糖控制%血糖变异性%重症监护
胰腺炎,急性%血糖控製%血糖變異性%重癥鑑護
이선염,급성%혈당공제%혈당변이성%중증감호
Acute pancreatitis%Glucose control%Glucose variability%Intensive care
目的 探讨强化血糖控制( IGC)对重症急性胰腺炎(SAP)患者血糖变异性(GV)及预后的影响；评价反映GV大小的参数血糖值标准差(GLUsD)、平均血糖波动幅度(GLUMAGE)及血糖不稳定指数(GLUGLI)对病死率的预测价值.方法 采用前瞻性随机对照临床研究.入选的SAP患者按随机数字表法分为IGC组(目标血糖6.1～8.3 mmol/L)和对照组(不加干预).比较两组GV大小、重症监护病房(ICU)病死率、感染发生率、机械通气时间及ICU住院时间等指标；选择GLUSD、GLUMAGE和GLUGLI代表GV,分别与ICU病死率进行双变量相关性分析,并应用受试者工作特征曲线下面积(AUC)评价其对病死率的预测价值.结果 共纳入30例患者,每组15例,两组基线资料具有可比性.与对照组比较,IGC具有减少GV参数GLUSD[ mmol/L:1.81 (0.97,2.65)比2.48(1.29,2.87)]、GLUMAGE [mmol/L:3.76 (3.67,5.85)比5.30 (4.35,6.80)]、GLUGLI[306.8 (220.6,613.3)比339.5(218.4,423.1)],降低ICU病死率(13.3％比40.0％)的趋势,但差异无统计学意义(均P＞0.05)；而IGC可缩短ICU住院时间(d:11.3±9.9比15.8±7.6,P＜0.01),降低血源性感染及肺部感染的发生率(6.7％比40.0％;33.3％比73.3％,均P＜0.05).GLUGLI与ICU病死率呈显著正相关(r=0.371,P=0.044),而GLUSD、GLUMAGE与ICU病死率无相关性(r值分别为-0.144和-0.065,P值分别为0.448和0.731).GLUSD、GLUMAGE和GLUGLI的AUC分别为0.594、0.543和0.751,95％可信区间(95％CI)分别为0.382～0.805、0.287～0.798、0.548～0.954,P值分别为0.439、0.725、0.046,说明GLUGLI对ICU病死率的预测价值较大.结论 IGC有减少SAP患者血糖波动、降低ICU病死率的趋势,可缩短ICU住院时间,降低感染的发生率.与GLUSD和GLUMACE相比,GLUGLI对ICU病死率的预测价值较好.
目的 探討彊化血糖控製( IGC)對重癥急性胰腺炎(SAP)患者血糖變異性(GV)及預後的影響；評價反映GV大小的參數血糖值標準差(GLUsD)、平均血糖波動幅度(GLUMAGE)及血糖不穩定指數(GLUGLI)對病死率的預測價值.方法 採用前瞻性隨機對照臨床研究.入選的SAP患者按隨機數字錶法分為IGC組(目標血糖6.1～8.3 mmol/L)和對照組(不加榦預).比較兩組GV大小、重癥鑑護病房(ICU)病死率、感染髮生率、機械通氣時間及ICU住院時間等指標；選擇GLUSD、GLUMAGE和GLUGLI代錶GV,分彆與ICU病死率進行雙變量相關性分析,併應用受試者工作特徵麯線下麵積(AUC)評價其對病死率的預測價值.結果 共納入30例患者,每組15例,兩組基線資料具有可比性.與對照組比較,IGC具有減少GV參數GLUSD[ mmol/L:1.81 (0.97,2.65)比2.48(1.29,2.87)]、GLUMAGE [mmol/L:3.76 (3.67,5.85)比5.30 (4.35,6.80)]、GLUGLI[306.8 (220.6,613.3)比339.5(218.4,423.1)],降低ICU病死率(13.3％比40.0％)的趨勢,但差異無統計學意義(均P＞0.05)；而IGC可縮短ICU住院時間(d:11.3±9.9比15.8±7.6,P＜0.01),降低血源性感染及肺部感染的髮生率(6.7％比40.0％;33.3％比73.3％,均P＜0.05).GLUGLI與ICU病死率呈顯著正相關(r=0.371,P=0.044),而GLUSD、GLUMAGE與ICU病死率無相關性(r值分彆為-0.144和-0.065,P值分彆為0.448和0.731).GLUSD、GLUMAGE和GLUGLI的AUC分彆為0.594、0.543和0.751,95％可信區間(95％CI)分彆為0.382～0.805、0.287～0.798、0.548～0.954,P值分彆為0.439、0.725、0.046,說明GLUGLI對ICU病死率的預測價值較大.結論 IGC有減少SAP患者血糖波動、降低ICU病死率的趨勢,可縮短ICU住院時間,降低感染的髮生率.與GLUSD和GLUMACE相比,GLUGLI對ICU病死率的預測價值較好.
목적 탐토강화혈당공제( IGC)대중증급성이선염(SAP)환자혈당변이성(GV)급예후적영향；평개반영GV대소적삼수혈당치표준차(GLUsD)、평균혈당파동폭도(GLUMAGE)급혈당불은정지수(GLUGLI)대병사솔적예측개치.방법 채용전첨성수궤대조림상연구.입선적SAP환자안수궤수자표법분위IGC조(목표혈당6.1～8.3 mmol/L)화대조조(불가간예).비교량조GV대소、중증감호병방(ICU)병사솔、감염발생솔、궤계통기시간급ICU주원시간등지표；선택GLUSD、GLUMAGE화GLUGLI대표GV,분별여ICU병사솔진행쌍변량상관성분석,병응용수시자공작특정곡선하면적(AUC)평개기대병사솔적예측개치.결과 공납입30례환자,매조15례,량조기선자료구유가비성.여대조조비교,IGC구유감소GV삼수GLUSD[ mmol/L:1.81 (0.97,2.65)비2.48(1.29,2.87)]、GLUMAGE [mmol/L:3.76 (3.67,5.85)비5.30 (4.35,6.80)]、GLUGLI[306.8 (220.6,613.3)비339.5(218.4,423.1)],강저ICU병사솔(13.3％비40.0％)적추세,단차이무통계학의의(균P＞0.05)；이IGC가축단ICU주원시간(d:11.3±9.9비15.8±7.6,P＜0.01),강저혈원성감염급폐부감염적발생솔(6.7％비40.0％;33.3％비73.3％,균P＜0.05).GLUGLI여ICU병사솔정현저정상관(r=0.371,P=0.044),이GLUSD、GLUMAGE여ICU병사솔무상관성(r치분별위-0.144화-0.065,P치분별위0.448화0.731).GLUSD、GLUMAGE화GLUGLI적AUC분별위0.594、0.543화0.751,95％가신구간(95％CI)분별위0.382～0.805、0.287～0.798、0.548～0.954,P치분별위0.439、0.725、0.046,설명GLUGLI대ICU병사솔적예측개치교대.결론 IGC유감소SAP환자혈당파동、강저ICU병사솔적추세,가축단ICU주원시간,강저감염적발생솔.여GLUSD화GLUMACE상비,GLUGLI대ICU병사솔적예측개치교호.
Objective To investigate effects of intensive glucose control (IGC) on glucose variability (GV)and clinical outcomes in patients with severe acute pancreatitis (SAP),and to assess predictive values of different measures of GV on intensive care unit (ICU) death.Methods A prospective,randonized,non-blinded clinical trial was conducted.All adult patients with diagnosis of SAP,who were admitted to ICU of West China Hospital between July 1st 2010 and July 1st 2011,were enrolled.Eligible patients were randomly assigned to receive either IGC to maintain glucose level between 6.1 mmol/L and 8.3 mmol/L or control group (none intervention was given).GV,ICU mortality,the incidence of infection,length of mechanical ventilation and ICU stay of the two groups were compared.The standard deviation of blood glucose level (GLUSD),mean amplitude of glycemic excursion (GLUMAGE) and glycemic lability index (GLUGLI) were chosen as measures of GV to analyze the multi variable correlation between them and ICU mortality,and the ability of these three parameters was assessed in predicting ICU death using area under a receiver operating characteristic curve (AUC).Results One hundred and twenty-two patients were eligible for the study,and 30 patients with SAP were enrolled in the study,with 15 cases in each group.The basic data of the two groups were comparable.Compared with control group,IGC showed an effect to reduce GV,including GLUSD [mmol/L: 1.81 (0.97,2.65 ) vs.2.48 ( 1.29,2.87 ) ],GLUMAGE [ mmol/L: 3.76 (3.67,5.85 ) vs.5.30 (4.35,6.80) ],GLUGLI [ 306.8 (220.6,613.3 ) vs.339.5 (218.4,423.1 )],and lower ICU mortality (13.3％ vs.40.0％ ),but the difference showed no significant difference (all P＞0.05).It could also shorten the length of ICU stay (days: 11.3±9.9 vs.15.8 ±7.6,P＜0.01),decrease the incidence of infection of blood stream and the lung (6.7％ vs.40.0％; 33.3％ vs.73.3％,both P＜0.05 ).A possitive correlation between GLUGLU and ICU mortality was found (r=0.371,P=0.044),but no correlation was found between GLUsD or GLUMAGE and ICU mortality (rvalue was -0.144 and -0.065,P value was 0.448 and 0.731 ).AUC for GLUSD,GLUMAGE and GLUGLI was 0.594 [95％ confidence interval (95％ CI) 0.382-0.805],0.543 (95％ CI 0.287-0.798) and 0.751 (95％ CI 0.548-0.954) respectively,and GLUGLI was the best predictor of ICU death.Conclusions IGC had an effect to reduce GV,decrease ICU mortality,shorten length of ICU stay,and lower the incidence of infection.Compared with GLUSD and GLUMAGE,GLUGLI was the best predictor of ICU death.
