CAJ | 학술논문

目的分析危重患儿血糖和胰岛素水平变化,探讨危重患儿高血糖发生相关机制.方法检测2007年1至12月我院PICU收治的51例危重患儿入院时血糖和胰岛素水平变化,并与15例健康体检儿检测结果进行对照分析.结果 (1)各种基础疾病下的危重患儿入院24 h内血糖均值均高于正常范围,以感染性休克组为最高[(11.35±6.21)mmol/L];患儿入院5 d内每日血糖均值波动情况以入院当天为最高,其后持续高于正常.(2)人院24 h内肺部感染、颅内感染和感染性休克患儿血胰岛素水平分别为(17.65±16.85)mU/L、(13.45±7.33)mU/L、(16.24±12.41)mU/L,均高于对照组[(8.70±6.57)mU/L],而先天性心脏病组[(6.75±3.22)mU/L]略低于正常组,但各组间差异无显著性(F=0.356,P=0.127);入院当天和第3天、第5天患儿血胰岛素平均水平均高于正常对照组[(8.70±6.57)mU/L];根据血糖水平,将患儿分为血糖正常组和高血糖组,两组血胰岛素水平分别为(5.44±3.38)mU/L、(14.22±12.29)mU/L,高血糖组胰岛素水平明显高于对照组.(3)患儿危重评分(PIM Ⅱ)均值为12.69±16.82,共死亡8例,病死率为15.6%;死亡患儿血糖和胰岛素水平均明显高于存活患儿(P＜0.05).(4)血糖和血胰岛素水平间无明显线性关系;危重症评分和血胰岛素水平无线性相关性;血糖和危重症评分间线性相关性不显著.结论危重症患儿常出现高血糖和高胰岛素血症,两者在一定程度上间接反映疾病严重程度,也是判断预后的间接指标;高血糖与胰岛素相对不足或(和)胰岛素抵抗有关,至于其确切的关系需要进一步研究证实.
목적 분석위중환인혈당화이도소수평변화,탐토위중환인고혈당발생상관궤제.방법 검측2007년1지12월아원PICU수치적51례위중환인입원시혈당화이도소수평변화,병여15례건강체검인검측결과진행대조분석.결과 (1)각충기출질병하적위중환인입원24 h내혈당균치균고우정상범위,이감염성휴극조위최고[(11.35±6.21)mmol/L];환인입원5 d내매일혈당균치파동정황이입원당천위최고,기후지속고우정상.(2)인원24 h내폐부감염、로내감염화감염성휴극환인혈이도소수평분별위(17.65±16.85)mU/L、(13.45±7.33)mU/L、(16.24±12.41)mU/L,균고우대조조[(8.70±6.57)mU/L],이선천성심장병조[(6.75±3.22)mU/L]략저우정상조,단각조간차이무현저성(F=0.356,P=0.127);입원당천화제3천、제5천환인혈이도소평균수평균고우정상대조조[(8.70±6.57)mU/L];근거혈당수평,장환인분위혈당정상조화고혈당조,량조혈이도소수평분별위(5.44±3.38)mU/L、(14.22±12.29)mU/L,고혈당조이도소수평명현고우대조조.(3)환인위중평분(PIM Ⅱ)균치위12.69±16.82,공사망8례,병사솔위15.6%;사망환인혈당화이도소수평균명현고우존활환인(P＜0.05).(4)혈당화혈이도소수평간무명현선성관계;위중증평분화혈이도소수평무선성상관성;혈당화위중증평분간선성상관성불현저.결론 위중증환인상출현고혈당화고이도소혈증,량자재일정정도상간접반영질병엄중정도,야시판단예후적간접지표;고혈당여이도소상대불족혹(화)이도소저항유관,지우기학절적관계수요진일보연구증실.
Objective To analyse the changes of blood glucose and insulin levels in children with critical illness,and to investigate the mechanism of hyperglycemia in critical illness.Methods Blood glucose and insulin levels were detected among 51 critically ill children hospitalized in our PICU from January to December,2007,which were compared with those of 15 healthy children.Results (1) All the patients had hyperglycemia after admission within 2Ah,septic shock patients showed the highest level with the maximum value of 27.30 mmol/L The dally mean blood glucose levels of the first 5 days after admission peaked on the admission day.(2) Within 24 h after admission,the blood insulin levels of patients with pulmonary infection,intracranial infection,septic shock and congenital heart disease were(17.65±16.85) mU/L,(13.45±7.33) mU/L,(16.24±12.41) mU/L,(6.75±3.22) mU/L respectively.The blood insulin levels of all the patients within the first 5 days after admission wrere higher than that of healthy children[(8.70±6.57) mU/L].According to blood glucose level on admission day,the patients were divided into normoglycemia and hyperglycemia group,and the blood insulin levels of the former and the letter were(5.44 ± 3.38) mU/L and (14.22±12.29) mU/L respectively.(3) The mean of PIM Ⅱscore of the patients averaged 12.96±16.82,and the mortality rate was 15.6%.The blood glucose level and the insulin level within 24 h after admission were(10.97±5.76) mmol/L and(49.46±90.35) mU/L in dead cases and(8.73±2.58) mmol/L and(11.91±11.24) mU/L for the survivals,and both the blood glucose level and insulin level had significant difference between the dead cases and survivals(P ＜0.05).(4) The scatter graphic analysis did not show significant linear relation between blood glucose and insulin,nor did it show significant linear relation between PIM Ⅱ and insulin levei,or blood glucose.Condusion Hyperglycemia and hyperinsulinemia are common in critical illness,which reflects indirectly the severity and prognosis of the disease.Hyperglycemia may be related to relative insulin insufficiency or insulin resistance;however,the definite relationship can not be confirmed until more reliable clinical data were available in the future.