中华内科杂志
中華內科雜誌
중화내과잡지
CHINESE JOURNAL OF INTERNAL MEDICINE
2013年
1期
30-33
,共4页
钱武强%金兆辰%蔡燕%孔宪如%吉木森
錢武彊%金兆辰%蔡燕%孔憲如%吉木森
전무강%금조신%채연%공헌여%길목삼
血糖%氧化性应激%危重病%死亡率
血糖%氧化性應激%危重病%死亡率
혈당%양화성응격%위중병%사망솔
Blood glucose%Oxidative stress%Critical illness%Mortality
目的 评估实时动态血糖监测对危重患者氧化应激及病死率的影响.方法 入选的急重症患者分为实时动态血糖监测组(A组,61例)和血糖仪监测组(B组,62例),监测两组平均血糖漂移幅度(MAGE)、低血糖指数、高血糖指数、血浆8-异前列腺素F2α水平,记录两组患者28 d病死率,并对上述指标进行相关分析.结果 A组MAGE、低血糖持续时间[(2.42±0.27)h]、低血糖指数(0.0011)及高血糖指数(0.2258)均较B组下降[(5.90±0.67) h;0.0119;0.3697].A组血浆8-异前列腺素F2α水平随时间推移较B组逐渐下降.血浆8-异前列腺素F2 α水平与MAGE、低血糖指数、高血糖指数呈正相关.A组病死率(9.84％)较B组(30.65％)下降(x2=8.22,P＜0.01).结论 实时动态血糖监测能有效改善危重患者的低血糖、高血糖、血糖变异及氧化应激,血糖控制、氧化应激的改善可降低患者病死率.
目的 評估實時動態血糖鑑測對危重患者氧化應激及病死率的影響.方法 入選的急重癥患者分為實時動態血糖鑑測組(A組,61例)和血糖儀鑑測組(B組,62例),鑑測兩組平均血糖漂移幅度(MAGE)、低血糖指數、高血糖指數、血漿8-異前列腺素F2α水平,記錄兩組患者28 d病死率,併對上述指標進行相關分析.結果 A組MAGE、低血糖持續時間[(2.42±0.27)h]、低血糖指數(0.0011)及高血糖指數(0.2258)均較B組下降[(5.90±0.67) h;0.0119;0.3697].A組血漿8-異前列腺素F2α水平隨時間推移較B組逐漸下降.血漿8-異前列腺素F2 α水平與MAGE、低血糖指數、高血糖指數呈正相關.A組病死率(9.84％)較B組(30.65％)下降(x2=8.22,P＜0.01).結論 實時動態血糖鑑測能有效改善危重患者的低血糖、高血糖、血糖變異及氧化應激,血糖控製、氧化應激的改善可降低患者病死率.
목적 평고실시동태혈당감측대위중환자양화응격급병사솔적영향.방법 입선적급중증환자분위실시동태혈당감측조(A조,61례)화혈당의감측조(B조,62례),감측량조평균혈당표이폭도(MAGE)、저혈당지수、고혈당지수、혈장8-이전렬선소F2α수평,기록량조환자28 d병사솔,병대상술지표진행상관분석.결과 A조MAGE、저혈당지속시간[(2.42±0.27)h]、저혈당지수(0.0011)급고혈당지수(0.2258)균교B조하강[(5.90±0.67) h;0.0119;0.3697].A조혈장8-이전렬선소F2α수평수시간추이교B조축점하강.혈장8-이전렬선소F2 α수평여MAGE、저혈당지수、고혈당지수정정상관.A조병사솔(9.84％)교B조(30.65％)하강(x2=8.22,P＜0.01).결론 실시동태혈당감측능유효개선위중환자적저혈당、고혈당、혈당변이급양화응격,혈당공제、양화응격적개선가강저환자병사솔.
Objective To evaluate the effects of real-time continuous glucose monitoring (RT-CGM) system on oxidative stress and mortality in critically ill patients and to explore the correlation between glucose index,oxidative stress and mortality.Methods Selected 123 cases of critically ill patients were enrolled in this prospective randomized controlled study.They were randomly divided into the RT-CGM group(n =61) and blood glucose meter group (GM group,n =62).The following parameters were compared between the two groups:mean amplitude of glucose excursions (MAGE),hypoglycemia incidence,low blood glucose index (LBGI),high blood glucose index (HBGI),28-day mortality and plasma level of 8-iso-PGF2α (8-iso) at 48 hours (R2),72 hours (R3) and 96 hours(R4) after admission to ICU.The correlation between glucose index and plasma level of 8-iso-PGF2α were analyzed.The correlation between glucose index,plasma 8-iso level and 28-day death were analyzed.Results The parameters of MAGE,hypoglycemia incidence,LBGI and HBG1 in the RT-CGM group and the GM group were (3.73 ±1.09) mmol/Land (4.19±1.11)mmol/L(P=0.02),3.28％ and 14.52％(P=0.03),0.0011 and 0.0119 (P ＜ 0.01) and 0.2258 and 0.3697 (P ＜ 0.01),respectively.The plasma levels of 8-iso at R2,R3,R4 in the RT-CGM group and the GM group were (111.44 ± 16.99) ng/L and (114.03 ± 14.64) ng/L(P=0.37),(94.53 ±14.92)ng/L and (110.31 ±13.42) ng/L(P＜0.01) and (57.84±12.22) ng/L and (84.41 ± 14.16)ng/L(P ＜0.01),respectively.The r values between MAGE,LBGI,HBGI and the plasma level of 8-iso were 0.69,0.71 and 0.67,respectively (all P values ＜ 0.01).Multivariate stepwise regression analysis showed MAGE,LBGI,HBGI entered final models (corrected R2 =0.61,P ＜ 0.01) with β values of 0.64,0.65 and 0.6 respectively(all P values ＜0.01).The 28-day mortality in the RT-CGM group and the GM group was 9.84％ and 30.65％ (P ＜0.01).The OR values of MAGE,hypoglycemia incidence,LBGI,HBGI and the plasma level of 8-iso for 28-day death were 2.14 (0.98-4.35),3.43 (1.12-5.82),2.67 (1.01-5.14),1.32 (0.24-2.96) and 1.89 (0.67-3.44),respectively.Conclusion RT-CGM can optimize the care in critically ill patients by improving hypoglycemia,hyperglycemia,glucose variability and oxidative stress and bring more detailed concern in the process,and to reduce the mortality.
