中国危重病急救医学
中國危重病急救醫學
중국위중병급구의학
CHINESE CRITICAL CARE MEDICINE
2009年
8期
466-469
,共4页
虞竹溪%顾勤%郑以山%刘宁
虞竹溪%顧勤%鄭以山%劉寧
우죽계%고근%정이산%류저
危重症%血糖波动%预后%强化胰岛素治疗
危重癥%血糖波動%預後%彊化胰島素治療
위중증%혈당파동%예후%강화이도소치료
critical illness%blood glucose variability%prognosis%intensive insulin therapy
目的 探讨血糖波动对重症监护病房(ICU)危重症患者预后的影响.方法 回顾性分析90例ICU危重症患者的临床资料,监测入住ICU 72 h内血糖值,记录初始血糖(GluAdm)、平均血糖(GluAve)、血糖标准差(GluSD)、血糖变异系数(GluCV).按患者预后分为存活组(49例)与死亡组(41例),比较两组间GluAdm、GluAve、GluSD、GluCV的差异,应用受试者工作特征曲线(ROC曲线)评价血糖波动与预后的相关性.根据GluSD、GluCV值平均分为4个亚组,比较各亚组间ICU病死率及院内病死率.结果 死亡组患者GluAdm、GluAve、GluSD、GluCV均明显高于存活组[GluAdm:(11.47±3.91)mmol/L比(9.23±2.96)mmol/L,GluAve:(9.22±1.31)mmol/L比(8.28±1.15)mmol/L,GluSD:(2.62±0.97)mmol/L比(1.66±0.64)mmol/L,GluCV:0.28±0.10比0.20±0.07,P均<0.05];GluSD、GluCV的ROC曲线下面积(AUC)分别为0.782±0.049和0.757±0.053,明显高于GluAdm、GluAve的AUC(分别为0.669±0.058和0.690±0.056,P均<0.05).GluSD 4.35～5.66 mmol/L组ICU病死率为95.7%,院内病死率为98.6%;GluCV 0.378～0.500组ICU病死率为83.3%,院内病死率为100.0%.结论 GluSD、GluCV升高与危重症患者ICU病死率和院内病死率显著相关,较GluAdm、GluAve评价预后更准确;降低血糖波动是有效控制血糖的重要策略.
目的 探討血糖波動對重癥鑑護病房(ICU)危重癥患者預後的影響.方法 迴顧性分析90例ICU危重癥患者的臨床資料,鑑測入住ICU 72 h內血糖值,記錄初始血糖(GluAdm)、平均血糖(GluAve)、血糖標準差(GluSD)、血糖變異繫數(GluCV).按患者預後分為存活組(49例)與死亡組(41例),比較兩組間GluAdm、GluAve、GluSD、GluCV的差異,應用受試者工作特徵麯線(ROC麯線)評價血糖波動與預後的相關性.根據GluSD、GluCV值平均分為4箇亞組,比較各亞組間ICU病死率及院內病死率.結果 死亡組患者GluAdm、GluAve、GluSD、GluCV均明顯高于存活組[GluAdm:(11.47±3.91)mmol/L比(9.23±2.96)mmol/L,GluAve:(9.22±1.31)mmol/L比(8.28±1.15)mmol/L,GluSD:(2.62±0.97)mmol/L比(1.66±0.64)mmol/L,GluCV:0.28±0.10比0.20±0.07,P均<0.05];GluSD、GluCV的ROC麯線下麵積(AUC)分彆為0.782±0.049和0.757±0.053,明顯高于GluAdm、GluAve的AUC(分彆為0.669±0.058和0.690±0.056,P均<0.05).GluSD 4.35～5.66 mmol/L組ICU病死率為95.7%,院內病死率為98.6%;GluCV 0.378～0.500組ICU病死率為83.3%,院內病死率為100.0%.結論 GluSD、GluCV升高與危重癥患者ICU病死率和院內病死率顯著相關,較GluAdm、GluAve評價預後更準確;降低血糖波動是有效控製血糖的重要策略.
목적 탐토혈당파동대중증감호병방(ICU)위중증환자예후적영향.방법 회고성분석90례ICU위중증환자적림상자료,감측입주ICU 72 h내혈당치,기록초시혈당(GluAdm)、평균혈당(GluAve)、혈당표준차(GluSD)、혈당변이계수(GluCV).안환자예후분위존활조(49례)여사망조(41례),비교량조간GluAdm、GluAve、GluSD、GluCV적차이,응용수시자공작특정곡선(ROC곡선)평개혈당파동여예후적상관성.근거GluSD、GluCV치평균분위4개아조,비교각아조간ICU병사솔급원내병사솔.결과 사망조환자GluAdm、GluAve、GluSD、GluCV균명현고우존활조[GluAdm:(11.47±3.91)mmol/L비(9.23±2.96)mmol/L,GluAve:(9.22±1.31)mmol/L비(8.28±1.15)mmol/L,GluSD:(2.62±0.97)mmol/L비(1.66±0.64)mmol/L,GluCV:0.28±0.10비0.20±0.07,P균<0.05];GluSD、GluCV적ROC곡선하면적(AUC)분별위0.782±0.049화0.757±0.053,명현고우GluAdm、GluAve적AUC(분별위0.669±0.058화0.690±0.056,P균<0.05).GluSD 4.35～5.66 mmol/L조ICU병사솔위95.7%,원내병사솔위98.6%;GluCV 0.378～0.500조ICU병사솔위83.3%,원내병사솔위100.0%.결론 GluSD、GluCV승고여위중증환자ICU병사솔화원내병사솔현저상관,교GluAdm、GluAve평개예후경준학;강저혈당파동시유효공제혈당적중요책략.
Objective To determine the association between glucose fluctuations and hospital mortality in intensive care unit (ICU) patients. Methods A retrospective study involving 90 critically ill patients in ICU according to the patients′ outcome were divided into survivors (49 cases) and nonsurvivors (41 cases), in whom the blood glucose level was monitored in the first 72 hours, and the initial blood glucose (GluAdm), the average blood glucose (GluAve), glucose standard deviation (GluSD), coefficient of variation glucose (GluCV) were determined, then GluAdm, GluAve, GluSD, and GluCV were compared between survivors and nonsurvivors, and the receiver operating characteristic curve (ROC curve) was applied to evaluate the association between blood glucose fluctuation and prognosis. According to the values of GluSD, GluCV, the critically patients were divided into four subgroups, and mortality in ICU and hospital was compared. Results The levels of GluAdm, GluAve, GluSD, GluCV of nonsurvivors were higher than those of survivors [GluAdm: (11.47±3.91) mmol/L vs. (9.23±2.96) mmol/L, GluAve: (9.22±1.31) mmol/L vs. (8.28±1.15) mmol/L, GluSD: (2.62±0.97) mmol/L vs. (1.66±0.64) mmol/L, GluCV: 0.28±0.10 vs. 0.20±0.07, all P<0.05]. When ROC was applied, the area under the curve (AUC) of GluSD, GluCV were 0.782±0.049 and 0.757±0.053, they were higher than that of the GluAdm and GluAve (0.669±0.058 and 0.690±0.056, both P<0.05). When GluSD was 4.355.66 mmol/L, the ICU mortality was 95.7%, hospital mortality was 98.6%; when GluCV was 0.3780.500, the ICU mortality was 83.3%, hospital mortality was 100.0%. Conclusion The increase in GluSD and GluCV in critically ill patients is significantly correlated with ICU mortality and hospital mortality, and they are more valuable in predicting ICU mortality than GluAdm, GluAve. Diminution in fluctuation of blood glucose might be an important aspect of glucose management.
