中国中西医结合急救杂志
中國中西醫結閤急救雜誌
중국중서의결합급구잡지
INTEGRATED TRADITIONAL CHINESE AND WESTERN MEDICINE IN PRACTICE OF CRITICAL CARE MEDICINE
2014年
1期
31-34
,共4页
向镜芬%杨祥%龚剑锋%雷伟健
嚮鏡芬%楊祥%龔劍鋒%雷偉健
향경분%양상%공검봉%뢰위건
动态血糖监测%颅脑损伤,重型
動態血糖鑑測%顱腦損傷,重型
동태혈당감측%로뇌손상,중형
Continuous glucose monitoring%Traumatic brain injury,severe
目的：探讨重型颅脑损伤患者进行动态血糖监测的临床意义。方法选取2012年1月至12月广东省清远市人民医院重症医学科诊断为重型颅脑损伤〔格拉斯哥昏迷评分（GCS）3～8分〕患者80例，按血糖监测方法分为动态血糖监测组（41例）及常规血糖监测组（39例）。动态血糖监测组采用动态血糖监测系统（CGMS）监测血糖，常规血糖监测组运用便携式血糖仪采集指尖血定时监测血糖；两组患者分别根据血糖监测情况进行胰岛素治疗。分析两组患者血糖波动情况、低血糖发生情况与患者急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分及预后的关系。结果两组患者血糖波动〔平均血糖波动幅度（MAGE）及血糖变异系数（GluCV）〕均与APACHEⅡ评分相关。特重型（GCS 3~5分）患者的MAGE明显高于重型（GCS 6~8分）的患者，而随着APACHEⅡ评分的增加，患者MAGE逐渐升高，差异均有统计学意义（均P＜0.05）。动态监测组低血糖发生率（7.32%比23.08%）及30 d病死率（12.20%比30.77%）均低于常规监测组（均P＜0.05）。动态监测组MAGE与30 d病死率呈正相关（r＝0.597，P＝0.007）；常规监测组GluCV与30 d病死率呈正相关（r＝0.622，P＝0.019）。结论动态血糖监测，可及时反映重症患者血糖波动情况，避免低血糖及高血糖的发生，并指导胰岛素治疗，改善患者预后。
目的：探討重型顱腦損傷患者進行動態血糖鑑測的臨床意義。方法選取2012年1月至12月廣東省清遠市人民醫院重癥醫學科診斷為重型顱腦損傷〔格拉斯哥昏迷評分（GCS）3～8分〕患者80例，按血糖鑑測方法分為動態血糖鑑測組（41例）及常規血糖鑑測組（39例）。動態血糖鑑測組採用動態血糖鑑測繫統（CGMS）鑑測血糖，常規血糖鑑測組運用便攜式血糖儀採集指尖血定時鑑測血糖；兩組患者分彆根據血糖鑑測情況進行胰島素治療。分析兩組患者血糖波動情況、低血糖髮生情況與患者急性生理學與慢性健康狀況評分繫統Ⅱ（APACHEⅡ）評分及預後的關繫。結果兩組患者血糖波動〔平均血糖波動幅度（MAGE）及血糖變異繫數（GluCV）〕均與APACHEⅡ評分相關。特重型（GCS 3~5分）患者的MAGE明顯高于重型（GCS 6~8分）的患者，而隨著APACHEⅡ評分的增加，患者MAGE逐漸升高，差異均有統計學意義（均P＜0.05）。動態鑑測組低血糖髮生率（7.32%比23.08%）及30 d病死率（12.20%比30.77%）均低于常規鑑測組（均P＜0.05）。動態鑑測組MAGE與30 d病死率呈正相關（r＝0.597，P＝0.007）；常規鑑測組GluCV與30 d病死率呈正相關（r＝0.622，P＝0.019）。結論動態血糖鑑測，可及時反映重癥患者血糖波動情況，避免低血糖及高血糖的髮生，併指導胰島素治療，改善患者預後。
목적：탐토중형로뇌손상환자진행동태혈당감측적림상의의。방법선취2012년1월지12월광동성청원시인민의원중증의학과진단위중형로뇌손상〔격랍사가혼미평분（GCS）3～8분〕환자80례，안혈당감측방법분위동태혈당감측조（41례）급상규혈당감측조（39례）。동태혈당감측조채용동태혈당감측계통（CGMS）감측혈당，상규혈당감측조운용편휴식혈당의채집지첨혈정시감측혈당；량조환자분별근거혈당감측정황진행이도소치료。분석량조환자혈당파동정황、저혈당발생정황여환자급성생이학여만성건강상황평분계통Ⅱ（APACHEⅡ）평분급예후적관계。결과량조환자혈당파동〔평균혈당파동폭도（MAGE）급혈당변이계수（GluCV）〕균여APACHEⅡ평분상관。특중형（GCS 3~5분）환자적MAGE명현고우중형（GCS 6~8분）적환자，이수착APACHEⅡ평분적증가，환자MAGE축점승고，차이균유통계학의의（균P＜0.05）。동태감측조저혈당발생솔（7.32%비23.08%）급30 d병사솔（12.20%비30.77%）균저우상규감측조（균P＜0.05）。동태감측조MAGE여30 d병사솔정정상관（r＝0.597，P＝0.007）；상규감측조GluCV여30 d병사솔정정상관（r＝0.622，P＝0.019）。결론동태혈당감측，가급시반영중증환자혈당파동정황，피면저혈당급고혈당적발생，병지도이도소치료，개선환자예후。
Objective To investigate the clinicial significance of continuous glucose monitoring(CGM)of patients with severe traumatic brain injury(sTBI). Methods By glucose monitoring method,80 patients with sTBI〔Glasgow coma score(GCS)3-8〕in Department of Critical Care Medicine of Qingyuan People's Hospital in Guangdong Province from January 2012 to December 2012 were divided into two groups:41 patients in CGM group and 39 in regular glucose monitoring(RGM)group. The continuous glucose monitoring system(CGMS)was applied to monitor glucose level in the CGM group,and the finger blood was taken by portable blood glucose meter in the RGM group. The two groups were treated with insulin on the basis of glucose level,respectively. The relationships between the condition of glycemic excursions and the acute physiology and chronic health evaluationⅡ(APACHEⅡ)score or prognosis and between the incidence of hypoglycemia and prognosis were seen in the two groups. Results The close linear correlations between APACHEⅡ score and glycemic excursion in two groups,i.e. mean amplitude of glycemic excursions(MAGE)and coefficient of variation of glucose(GluCV),were documented(both P<0.05). The MAGE of the especially severe patients(GCS 3-5)was obviously higher than that of severe ones(GCS 6-8),and with the increase of APACHEⅡ score,the MAGE of patients was gradually elevated,the difference being statistically significant(both P<0.05). The incidence of hypoglycemia(7.32%vs. 23.08%)and fatality rate of 30 days(12.20%vs. 30.77%)in CGM group were lower than those of RGM group(both P<0.05). The MAGE and fatality rate of 30 days were positively correlated in CGM group(r=0.597,P=0.007),and the GLuCV and fatality rate of 30 days were positively correlated in RGM group(r=0.622,P=0.019). Conclusion CGM is beneficial to timely observe condition of glycemic excursions in sTBI patients and avoid occurrence of hypoglycemia or hyperglycemia,guiding the treatment of insulin and improving patients' prognosis.
