CAJ | 학술논문

目的调查并探讨内科首症监护病房(ICU)住院患者高血糖发生率及高血糖管理与病情、预后的关系.方法利用病案查询系统检索上海交通大学医学院附属仁济医院2002至2009年内科ICU住院患者病历,对所有资料进行同顾性分析.结果 (1)共纳入2 631例患者,2 168例患者在住院期间测定血糖至少一次,高血糖发生率26.3%,其中既往有糖尿病病史者占12.9%,无糖尿病病史的高血糖患者占13.4%.既往有糖尿病病史合并高血糖的患者中,93.2%住院期间给予了降糖治疗,降糖方案以口服药物(53.0%)和皮下注射胰岛素(24.9%)为主;在既往无糖尿病病史的高血糖患者中,84.4%的患者住院期间没有给予任何降糖治疗;与既往有糖尿病病史合并的高血糖组相比,该组死亡率明显升高(30.4%对13.9%,P<0.01).(2)在既往有糖尿病病史组中,与组内血糖≤7.0 mmol/L亚组相比,血糖>10 mmol/L亚组的死亡率升高(20.5%对9.9%,P<0.05);既往无糖尿病病史的高血糖患者,当血糖>7.0 mmol/L时,则死亡率就开始升高(P<0.01).(3)多元逐步回归分析显示平均血糖是死亡的独立危险因素(OR:1.26).结论内科ICU住院患者高血糖发生率高,其血糖管理及治疗须引起重视;危重患者高血糖水平可能是死亡率增加的独立危险因素.
목적 조사병탐토내과수증감호병방(ICU)주원환자고혈당발생솔급고혈당관리여병정、예후적관계.방법 이용병안사순계통검색상해교통대학의학원부속인제의원2002지2009년내과ICU주원환자병력,대소유자료진행동고성분석.결과 (1)공납입2 631례환자,2 168례환자재주원기간측정혈당지소일차,고혈당발생솔26.3%,기중기왕유당뇨병병사자점12.9%,무당뇨병병사적고혈당환자점13.4%.기왕유당뇨병병사합병고혈당적환자중,93.2%주원기간급여료강당치료,강당방안이구복약물(53.0%)화피하주사이도소(24.9%)위주;재기왕무당뇨병병사적고혈당환자중,84.4%적환자주원기간몰유급여임하강당치료;여기왕유당뇨병병사합병적고혈당조상비,해조사망솔명현승고(30.4%대13.9%,P<0.01).(2)재기왕유당뇨병병사조중,여조내혈당≤7.0 mmol/L아조상비,혈당>10 mmol/L아조적사망솔승고(20.5%대9.9%,P<0.05);기왕무당뇨병병사적고혈당환자,당혈당>7.0 mmol/L시,칙사망솔취개시승고(P<0.01).(3)다원축보회귀분석현시평균혈당시사망적독립위험인소(OR:1.26).결론 내과ICU주원환자고혈당발생솔고,기혈당관리급치료수인기중시;위중환자고혈당수평가능시사망솔증가적독립위험인소.
Objective To analyze the association of the morbidity,the management of blood glucose,and the prognosis of patients with hyperglycemia in the medical intensive care units(ICU).Methods Medical records of ICU patients of Renji Hospital from 2002 to 2009 were reviewed using Medical Record Inquiry System,and the data were retrospectively analyzed.Results(1)2631 subjects were included in the present study,blood glucose was determined at least once during hospitalization in 2168 of them.The incidence of hyperglycemia was 26.3%,in which 12.9% presented a known history of diabetes and 13.4% without.In the patients with diabetes history,93.2% of them received anti-diabetic treatment during hospitalization.mainly with oral anti-hyperglyeemic agents (53.0%)or subcutaneous insulin injection(24.9%).However,in the patients without diabetes history,84.4% were not treated against hyperglycemia.The mortality was increased in the latter group(30.4% vs13.9%,P<0.01).(2)In the patients with diabetes history,the mortality in patients whose blood glucose>10 mmol/L was higher than those with blood glucose≤7.0 mmol/L(20.5% vs 9.9%,P<0.05):while in the patients without diabetes history,the mortality began to rise as blood glucose>7.0 mmol/L(P<0.01).(3)Multiple stepwise regression analysis revealed that the average blood glucose level was an independent risk factor for death(OR=1.26).Conclusions The ICU patients showed a high prevalence of hyperglycemia,the management of hyperglycemia should be emphasized.Hyperglycemia in critically ill patients might be an independent risk factor of increased mortality.