中华急诊医学杂志
中華急診醫學雜誌
중화급진의학잡지
CHINESE JOURNAL OF EMERGENCY MEDICINE
2012年
5期
478-483
,共6页
刘萍萍%胥志跃%卢秀兰%杨梅雨%祝益民
劉萍萍%胥誌躍%盧秀蘭%楊梅雨%祝益民
류평평%서지약%로수란%양매우%축익민
危重症%高血糖%儿童%危重度
危重癥%高血糖%兒童%危重度
위중증%고혈당%인동%위중도
Critical condition%Hyperglycemia%Children%Severity
目的 分析重症患儿高血糖的临床特征及预后,探讨重症患儿血糖水平与病情危重度的关系.方法 分析2009年11月至2010年4月湖南省儿童医院儿科重症监护室(PICU)收治的349例重症患儿,入住PICU 24 h内静脉血糖≥11.1 mmol/L为重度升高组(n=67)；6.3～11.1mmol/L为轻度升高组(n=134)；≤6.3 mmol/L为对照组(n =148).监测入住PICU 24 h、3d、7d的血糖,入院时检测电解质、炎症指标、心肌酶、肝肾功能相关指标等,并记录与病情危重度及预后相关的指标.分类变量应用x2检验,连续变量比较使用t检验、F检验或U检验和H检验,相关性采用Pearson相关分析.结果 重度升高组、轻度升高组和对照组的最高血糖值分别为( 16.98±7.08) mmol/L、(8.25±1.40) mmol/L和(4.89±0.98)mmol/L (P ＜0.01),入院小儿危重病例评分分别为(81.22±8.25)、(86.71±6.40)和(86.15±6.99)(P＜0.01),并发脓毒症或脓毒性休克发生率分别为55.23％、30.59％和14.18％ (P＜0.01),并发多器官功能障碍综合征发生率分别为46.26％、22.39％和16.23％(P＜0.01).1个和2个器官衰竭时的血糖值分别为(8.27 ±3.75) mmol/L和(8.88±5.42) mmol/L (P＜0.05)；2个和多个器官衰竭时血糖值分别为(8.88 ±5.42) mmol/L和(13.09±8.23) mmol/L (P＜0.01).重度升高组、轻度升高组和对照组患儿病死率分别为47.76％、14.93％和10.13％(P＜0.01)；存活组入院时血糖水平为(7.57±4.11) mmol/L,死亡组为(12.46±8.17) mmol/L(P＜0.01).结论 PICU患儿高血糖的发生较常见,在一定程度上可反映疾病的严重程度,也是判断预后的重要指标；血糖水平与器官衰竭的数目、疾病的危重程度呈正相关,血糖越高,病情越危重,其预后越差.因此,动态监测血糖变化有利于掌握病情变化及判断预后.
目的 分析重癥患兒高血糖的臨床特徵及預後,探討重癥患兒血糖水平與病情危重度的關繫.方法 分析2009年11月至2010年4月湖南省兒童醫院兒科重癥鑑護室(PICU)收治的349例重癥患兒,入住PICU 24 h內靜脈血糖≥11.1 mmol/L為重度升高組(n=67)；6.3～11.1mmol/L為輕度升高組(n=134)；≤6.3 mmol/L為對照組(n =148).鑑測入住PICU 24 h、3d、7d的血糖,入院時檢測電解質、炎癥指標、心肌酶、肝腎功能相關指標等,併記錄與病情危重度及預後相關的指標.分類變量應用x2檢驗,連續變量比較使用t檢驗、F檢驗或U檢驗和H檢驗,相關性採用Pearson相關分析.結果 重度升高組、輕度升高組和對照組的最高血糖值分彆為( 16.98±7.08) mmol/L、(8.25±1.40) mmol/L和(4.89±0.98)mmol/L (P ＜0.01),入院小兒危重病例評分分彆為(81.22±8.25)、(86.71±6.40)和(86.15±6.99)(P＜0.01),併髮膿毒癥或膿毒性休剋髮生率分彆為55.23％、30.59％和14.18％ (P＜0.01),併髮多器官功能障礙綜閤徵髮生率分彆為46.26％、22.39％和16.23％(P＜0.01).1箇和2箇器官衰竭時的血糖值分彆為(8.27 ±3.75) mmol/L和(8.88±5.42) mmol/L (P＜0.05)；2箇和多箇器官衰竭時血糖值分彆為(8.88 ±5.42) mmol/L和(13.09±8.23) mmol/L (P＜0.01).重度升高組、輕度升高組和對照組患兒病死率分彆為47.76％、14.93％和10.13％(P＜0.01)；存活組入院時血糖水平為(7.57±4.11) mmol/L,死亡組為(12.46±8.17) mmol/L(P＜0.01).結論 PICU患兒高血糖的髮生較常見,在一定程度上可反映疾病的嚴重程度,也是判斷預後的重要指標；血糖水平與器官衰竭的數目、疾病的危重程度呈正相關,血糖越高,病情越危重,其預後越差.因此,動態鑑測血糖變化有利于掌握病情變化及判斷預後.
목적 분석중증환인고혈당적림상특정급예후,탐토중증환인혈당수평여병정위중도적관계.방법 분석2009년11월지2010년4월호남성인동의원인과중증감호실(PICU)수치적349례중증환인,입주PICU 24 h내정맥혈당≥11.1 mmol/L위중도승고조(n=67)；6.3～11.1mmol/L위경도승고조(n=134)；≤6.3 mmol/L위대조조(n =148).감측입주PICU 24 h、3d、7d적혈당,입원시검측전해질、염증지표、심기매、간신공능상관지표등,병기록여병정위중도급예후상관적지표.분류변량응용x2검험,련속변량비교사용t검험、F검험혹U검험화H검험,상관성채용Pearson상관분석.결과 중도승고조、경도승고조화대조조적최고혈당치분별위( 16.98±7.08) mmol/L、(8.25±1.40) mmol/L화(4.89±0.98)mmol/L (P ＜0.01),입원소인위중병례평분분별위(81.22±8.25)、(86.71±6.40)화(86.15±6.99)(P＜0.01),병발농독증혹농독성휴극발생솔분별위55.23％、30.59％화14.18％ (P＜0.01),병발다기관공능장애종합정발생솔분별위46.26％、22.39％화16.23％(P＜0.01).1개화2개기관쇠갈시적혈당치분별위(8.27 ±3.75) mmol/L화(8.88±5.42) mmol/L (P＜0.05)；2개화다개기관쇠갈시혈당치분별위(8.88 ±5.42) mmol/L화(13.09±8.23) mmol/L (P＜0.01).중도승고조、경도승고조화대조조환인병사솔분별위47.76％、14.93％화10.13％(P＜0.01)；존활조입원시혈당수평위(7.57±4.11) mmol/L,사망조위(12.46±8.17) mmol/L(P＜0.01).결론 PICU환인고혈당적발생교상견,재일정정도상가반영질병적엄중정도,야시판단예후적중요지표；혈당수평여기관쇠갈적수목、질병적위중정도정정상관,혈당월고,병정월위중,기예후월차.인차,동태감측혈당변화유리우장악병정변화급판단예후.
Objective To analyze the clinical features and prognosis of hyperglycemia and the relationship between the blood glucose level and the severity of disease in critically ill children.Methods A total of 349 critically ill children admitted in Pediatric Intensive Care Unit (PICU) from November 2009 to April 2010 were restrospectively analyzed.According to the levels of venous blood glucose within 24 h after admission,they were divided into very high level group (blood glucose ≥11.1 mmol/L,n =67 ),slightly high level group (blood glucose 6.3-11.1 mmol/L,n =134) and normal level group (blood glucose ≤6.3mmol/L,n =148).Blood glucose levels were measured within 24 hours,3 days and 7 days after admission.Electrolytes,inflammatory markers,cardiac enzymes,liver and kidney function as well as other biomarkers related to the severity and the prognosis of the patients were recorded after admission.The categorical variables were analyzed with Chi -squared test,the continuous variables were analyzed with t-test,F-test,U-test andH-test,and the correlation analysis was calculated by using Pearson Coefficients. Results In the very high level group,slightly high level group and normal level group,the average blood glucose levels were 16.98 ±7.08 mmol/L,8.25 ± 1.40 mmol/L and 4.89 ± 0.98 mmol/L ( P ＜ 0.01 ),respectively;and the Pediatric Critical Ⅲ Scores at admission were 81.22 ± 8.25,86.71 ± 6.40 and 86.15 ± 6.99 ( P ＜0.01 ),respectively,and the incidences of sepsis or septic shock were 55.23％,30.59％ and 14.18％,respectively (P ＜0.01 ),and the incidences of MODS were 46.26％,22.39％ and 16.23％,respectively (P ＜0.01 ).The blood glucose levels of patients with one organ failure and two organ failure were 8.27 ± 3.75 mmol/L and 8.88 ± 5.42 mmol/L,respectively ( P ＜ 0.05 ).The blood glucose levels of patients with two organ failure and multiple organ failure were 8.88 ± 5.42 mmol/L and 13.09 ± 8.23 mmol/L,respectively (P＜0.01).The mortality rates of three groups were 47.76％,14.93％ and 10.13％ (P ＜0.01 ),and the blood glucose levels at admission in survival group and death group were 7.57 ±4.11 mmol/L and 12.46 ± 8.17 mmol/L ( P ＜ 0.01 ).Conclusions Patients with hyperglycemia are often found in the PICU.It not only partially reflects the severity of the disease,but also serves as an important indicator for the prognosis.The blood glucose level is positively correlated to the number of compromised organs and the severity of the disease.Dynamic monitoring of blood glucose may be essential for controlling the symptoms and prediction of prognosis.
