CAJ | 학술논문

目的评估实施每日唤醒对多发伤患者血糖波动和病死率的影响.方法采用前瞻性研究方法,观察68例危重症患者入重症监护病房(ICU)实施每日唤醒计划后首个24 h内的血糖情况,每2h检测1次,计算血糖平均值(MEAN)、标准差(SD)、变异系数(CV)、血糖不稳定指数(GLI)、日内平均血糖波动幅度(MAGE)、最大血糖波动幅度(LAGE);记录30 d病死率.根据MEAN和GLI的中位数将患者分为低MEAN+低GLI组(A组,34例)、低MEAN+高GLI组(B组,14例)、高MEAN+低GLI组(C组,12例)、高MEAN+高GLI组(D组,8例)4组,比较各组间血糖水平、血糖波动情况及转归水平.结果 68例患者中共死亡5例,总体病死率为7.4％,其中A组预后最佳[病死率为0(0/34)],D组预后最差[病死率为37.5％(3/8)].血糖水平指标MEAN(mmol/L)以A、B组较低(6.7±1.3、7.6±0.8),C、D组较高(9.3±1.4、10.7±1.3).血糖波动指标SD(mmol/L)、CV、GLI、LAGE (mmol/L)、MAGE (mmol/L)以A、C组较低(SD:1.6±0.4、1.7±0.6,CV:0.2±0.1、0.2±0.1,GLI:26.5±19.5、40.1±17.6,LAGE:4.6±2.3、6.5±1.9,MAGE:2.7±0.8、3.1±0.8),B、D组较高(SD:2.9±0.7、3.9±0.8,CV:0.4±0.1、0.4±0.1,GLI:120.5±33.2、184.6±98.4,LAGE:9.5±2.0、12.7±4.0,MAGE:6.2±1.2、7.6±1.8).低血糖发生率以D组最高[5.8％(6/104)],B组次之[1.6％(3/182)],A、C组较低[0.9％(4/442),0.1％(2/256)].高血糖发生率以C、D组较高[67.3％(105/156)、69.2％(72/104)],B组次之[33.5％(61/182)],A组最低[15.4％(68/442)].A组的机械通气时间[(3.4±3.3)d]、多器官功能衰竭发生率[44.1％(15/34)]、连续性肾脏替代治疗(CRRT)使用率[11.8％(4/34)]、ICU住院时间[(5.1±3.9)d]均为最佳,D组最差[分别为(9.4±5.2)d、87.5％(7/8)、75.0％(4/8)、(10.3±7.4)d].结论每日唤醒可以减少多发伤患者血糖波动,改善患者预后.
목적 평고실시매일환성대다발상환자혈당파동화병사솔적영향.방법 채용전첨성연구방법,관찰68례위중증환자입중증감호병방(ICU)실시매일환성계화후수개24 h내적혈당정황,매2h검측1차,계산혈당평균치(MEAN)、표준차(SD)、변이계수(CV)、혈당불은정지수(GLI)、일내평균혈당파동폭도(MAGE)、최대혈당파동폭도(LAGE);기록30 d병사솔.근거MEAN화GLI적중위수장환자분위저MEAN+저GLI조(A조,34례)、저MEAN+고GLI조(B조,14례)、고MEAN+저GLI조(C조,12례)、고MEAN+고GLI조(D조,8례)4조,비교각조간혈당수평、혈당파동정황급전귀수평.결과 68례환자중공사망5례,총체병사솔위7.4％,기중A조예후최가[병사솔위0(0/34)],D조예후최차[병사솔위37.5％(3/8)].혈당수평지표MEAN(mmol/L)이A、B조교저(6.7±1.3、7.6±0.8),C、D조교고(9.3±1.4、10.7±1.3).혈당파동지표SD(mmol/L)、CV、GLI、LAGE (mmol/L)、MAGE (mmol/L)이A、C조교저(SD:1.6±0.4、1.7±0.6,CV:0.2±0.1、0.2±0.1,GLI:26.5±19.5、40.1±17.6,LAGE:4.6±2.3、6.5±1.9,MAGE:2.7±0.8、3.1±0.8),B、D조교고(SD:2.9±0.7、3.9±0.8,CV:0.4±0.1、0.4±0.1,GLI:120.5±33.2、184.6±98.4,LAGE:9.5±2.0、12.7±4.0,MAGE:6.2±1.2、7.6±1.8).저혈당발생솔이D조최고[5.8％(6/104)],B조차지[1.6％(3/182)],A、C조교저[0.9％(4/442),0.1％(2/256)].고혈당발생솔이C、D조교고[67.3％(105/156)、69.2％(72/104)],B조차지[33.5％(61/182)],A조최저[15.4％(68/442)].A조적궤계통기시간[(3.4±3.3)d]、다기관공능쇠갈발생솔[44.1％(15/34)]、련속성신장체대치료(CRRT)사용솔[11.8％(4/34)]、ICU주원시간[(5.1±3.9)d]균위최가,D조최차[분별위(9.4±5.2)d、87.5％(7/8)、75.0％(4/8)、(10.3±7.4)d].결론 매일환성가이감소다발상환자혈당파동,개선환자예후.
Objective To assess the influence of a protocol of routine daily interruption of sedation on fluctuation of blood glucose level and mortality of critical patients with multiple trauma.Methods A prospective study involving 68 critical patients with multiple trauma admitted to intensive care unit (ICU) was performed.Finger blood glucose level was measured after the implementation of daily interruption of sedation,and the results were recorded every 2 hours during the first 24 hours.Mean (MEAN),standard deviation (SD) and coefficient of variability (CV) of blood glucose level,glycemic liability index (GLI),mean amplitude of glycemic excursion (MAGE) and largest amplitude of glycemic excursions (LAGE) were calculated respectively,and 30-day mortality was recorded.The patients under study were divided into four groups according to the median values of MEAN and GLI,group A with patients of low MEAN + low GLI (n=34),group B with patients of low MEAN + high GLI (n=14),group C with patients of high MEAN + low GLI (n =12),and group D with patients of high MEAN + high GLI (n =8).Glucose levels,their range of fluctuation,and the prognosis were compared among groups.Results Five of the 68 patients died,with a gross mortality rate of 7.4％.Group analysis demonstrated that the patients in group A had the best prognosis with the 30-day mortality rate of 0 (0/34),while that of the group D was worst with the 30-day mortality rate of 37.5％ (3/8).The MEAN levels of glucose (mmol/L) were relatively lower in groups A and B (6.7 ± 1.3,7.6 ±0.8) and higher in groups C and D (9.3 ± 1.4,10.7 ± 1.3).Indicators of glucose level fluctuation,including SD (mmol/L),CV,GLI,LAGE (mmol/L),and MAGE (mmol/L),were lower in groups A and C (SD:1.6 ±0.4,1.7 ±0.6; CV:0.2 ±0.1,0.2 ±0.1; GLI:26.5 ± 19.5,40.1 ± 17.6; LAGE:4.6 ± 2.3,6.5 ± 1.9; MAGE:2.7 ± 0.8,3.1 ± 0.80),and higher in groups B and D (SD:2.9 ± 0.7,3.9 ±0.8; CV:0.4 ±0.1,0.4 ±0.1; GLI:120.5 ± 33.2,184.6 ± 98.4; LAGE:9.5 ± 2.0,12.7 ± 4.0; MAGE:6.2 ± 1.2,7.6 ± 1.8).The incidence of hypoglycemia was highest in group D [5.8％ (6/104)],followed by that of group B [1.6％ (3/182)],while that of groups A and C was lower [0.9％ (4/442),0.1％ (2/256)].The incidence of hyperglycemia were highest in groups C and D [67.3％ (105/156),69.2％ (72/104)],and it was followed by that of group B [33.5％ (61/182)],and that of group A was the lowest [15.4％ (68/442)].The duration of mechanical ventilation [(3.4 ± 3.3) days],the incidence of multiple organ failure (MOF,44.1％,15/34),rate of continuous renal replacement therapy (CRRT,11.8％,4/34),and day in ICU [(5.1 ± 3.9) days] were shortest and lowest in group A,and highest and longest in group D [(9.4-± 5.2) days,87.5％ (7/8),75.0％ (4/8),(10.3 ± 7.4) days].Conclusion Daily interruption of sedation can reduce fluctuation of blood glucose level in critical patients with multiple trauma,and improve patients' outcome.