CAJ | 학술논문

目的探讨低血糖是否可导致危重症患者死亡率增高及中、重度低血糖的特点。方法回顾性研究了重症监护病房中5018例危重症患者中、重度低血糖（血糖分别是：41~70 mg/dL [2.3~3.9 mmol/L]和≤40 mg/d L [2.2 mmol/L]）和死亡的关系。并分析了两种低血糖流行病学特点。结果随访数据表明5018例患者中：1222（24.4%）有中度低血糖，其中234例（19.1%）患者是在严格控制血糖组，86例患者（1.8%）有重度低血糖，其中39例（45.3%）是在严格控制血糖组，3690例（73.5%）患者无低血糖，612（16.6%）例死亡，对比1222例中度低血糖患者中339例死亡（27.7%），86例重度低血糖患者中42人死亡（48.8%）。低血糖患者死亡率（28.7%）高于无低血糖患者（16.6%）（P＜0.05），重度低血糖组死亡率（48.8%）高于中度低血糖组（27.7%）（P＜0.05）；重度低血糖组APACHEⅡ评分、ICU住院时间明显高于中度低血糖组（P均＜0.05）。结论低血糖在临床发病率仍然很高，可提高危重症患者的死亡率，并且随低血糖程度的加深，死亡率也增高，应在临床予以重视。
목적탐토저혈당시부가도치위중증환자사망솔증고급중、중도저혈당적특점。방법회고성연구료중증감호병방중5018례위중증환자중、중도저혈당（혈당분별시：41~70 mg/dL [2.3~3.9 mmol/L]화≤40 mg/d L [2.2 mmol/L]）화사망적관계。병분석료량충저혈당류행병학특점。결과수방수거표명5018례환자중：1222（24.4%）유중도저혈당，기중234례（19.1%）환자시재엄격공제혈당조，86례환자（1.8%）유중도저혈당，기중39례（45.3%）시재엄격공제혈당조，3690례（73.5%）환자무저혈당，612（16.6%）례사망，대비1222례중도저혈당환자중339례사망（27.7%），86례중도저혈당환자중42인사망（48.8%）。저혈당환자사망솔（28.7%）고우무저혈당환자（16.6%）（P＜0.05），중도저혈당조사망솔（48.8%）고우중도저혈당조（27.7%）（P＜0.05）；중도저혈당조APACHEⅡ평분、ICU주원시간명현고우중도저혈당조（P균＜0.05）。결론저혈당재림상발병솔잉연흔고，가제고위중증환자적사망솔，병차수저혈당정도적가심，사망솔야증고，응재림상여이중시。
Objective To analyze whether hypoglycemia leads to a increase of death in critically ill patients and retrospectively the clinic characters of moderate and severe hypoglycemia. Methods We retrospectively examined the associations between moderate and severe hypoglycemia (blood glucose,41 to 70 mg per deciliter [2.3 to 3.9 mmol per liter] and ≤40 mg per deciliter [2.2 mmol per liter],respectively) and death among 5018 critically ill patients in intensive care units (ICUs). And the clinic characters of moderate and severe hypoglycemia. Results Follow-up data were available for 3018 patients:1222(24.4%) had moderate hypoglycemia, 234 of whom(19.1%)were in the intensive-control group,and 86 patients (1.8%) had severe hypoglycemia,39 of whom(45.3%) were in the intensive-control group. Of the 3690 patients (73.5%)who did not have hypoglycemia,612(16.6%) died,as compared with 339 of the 1222 with moderate hypoglycemia (27.7%) and 49 of the 86 with severe hypoglycemia 48.8%). The mortality of patients with hypoglycemia was higher than in patients without hypoglycemia,severe hypoglycemia was higher than moderate(all P < 0.05). The APACHE Ⅱ score and length of stay in ICU in severe hypoglycemia group were higher than in moderate hypoglycemia group(P < 0.05). Conclusion The incidences of hypoglycemia is still high,more severe hyperglycemia is associated with higher morbidity and mortality.