CAJ | 학술논문

目的：探讨血糖水平和血糖变异度对成人复杂腹腔感染术后28 d生存率的预测价值。方法采用前瞻性研究方法，对2012-07～2013-09转入ICU的成人复杂腹腔感染术后患者进行间断血糖监测和预后观察，血糖监测终点为转入ICU后24 h，预后观察终点为转入ICU后28 d；统计转入时血糖（ GLUadm ）、血糖最大值（ GLUmax ）、血糖最小值（ GLUmin ）、计算患者转入ICU时的急性生理学与慢性健康状况评分Ⅱ（ APACHEⅡ）、感染相关器官功能不全评分（ SOFA）、血糖差值（ GLUdif ）、血糖平均值（ GLUave ）、血糖标准差（ GLUsd ）、血糖变异系数（ GLUcv ）和平均血糖漂移幅度（ MAGE）。按患者预后分为存活组和死亡组。结果89例成人复杂腹腔感染患者纳入研究，其中存活组54例，死亡组35例，两组患者年龄、性别、原发病、GLUadm、APACHEⅡ评分和SOFA评分均差异无统计学意义（P＞0．05）。存活组GLUmax、GLUdif和MAGE均显著低于死亡组，差异有统计学意义（P值分别为0．028、0．039和0．019）。 MAGE、GLUmax和GLUdif三者ROC曲线下面积分别为0．806、0．787和0．769。当GLUmax取临界值为15．4 mmol/L时，敏感度和特异度分别为77．8％和83．3％。结论血糖水平和血糖变异度是影响成人复杂腹腔感染术后28 d生存率的重要因素，转入ICU后24 h内GLUmax是预测成人复杂腹腔感染术后28 d生存率的良好指标，最佳临界值为15．4 mmol/L。
목적：탐토혈당수평화혈당변이도대성인복잡복강감염술후28 d생존솔적예측개치。방법채용전첨성연구방법，대2012-07～2013-09전입ICU적성인복잡복강감염술후환자진행간단혈당감측화예후관찰，혈당감측종점위전입ICU후24 h，예후관찰종점위전입ICU후28 d；통계전입시혈당（ GLUadm ）、혈당최대치（ GLUmax ）、혈당최소치（ GLUmin ）、계산환자전입ICU시적급성생이학여만성건강상황평분Ⅱ（ APACHEⅡ）、감염상관기관공능불전평분（ SOFA）、혈당차치（ GLUdif ）、혈당평균치（ GLUave ）、혈당표준차（ GLUsd ）、혈당변이계수（ GLUcv ）화평균혈당표이폭도（ MAGE）。안환자예후분위존활조화사망조。결과89례성인복잡복강감염환자납입연구，기중존활조54례，사망조35례，량조환자년령、성별、원발병、GLUadm、APACHEⅡ평분화SOFA평분균차이무통계학의의（P＞0．05）。존활조GLUmax、GLUdif화MAGE균현저저우사망조，차이유통계학의의（P치분별위0．028、0．039화0．019）。 MAGE、GLUmax화GLUdif삼자ROC곡선하면적분별위0．806、0．787화0．769。당GLUmax취림계치위15．4 mmol/L시，민감도화특이도분별위77．8％화83．3％。결론혈당수평화혈당변이도시영향성인복잡복강감염술후28 d생존솔적중요인소，전입ICU후24 h내GLUmax시예측성인복잡복강감염술후28 d생존솔적량호지표，최가림계치위15．4 mmol/L。
Objective To investigate the predictive value in blood glucose concentration and blood glucose variability to 28-day survival rate in adults with complicated intra -abdominal infection after surgical operation .Methods A prospective study was conducted .Blood glucose monitoring and prognosis observation were performed for the adult non -diabetic patients with complicated intra -abdominal infection admitted in ICU from July 2012 to September 2013 .Blood monitoring terminal was 24 hours after admitted in ICU .Prognosis observation terminal was 28 days after admitted in ICU .The blood glucose concentration admitted in ICU , the maximum and minimum values of blood glucose were recorded.Acute physiology and chronic health evaluation Ⅱ( APACHEⅡ) scores, sequential organ failure assessment ( SOFA) , differential value of blood glucose ( GLUdif ) , average value of blood glucose (GLUave) and standard deviation (GLUsd), coefficient of blood glucose (GLUcv), mean absolute blood glucose fluctuation amplitude ( MAGE) were calculated .Patients were divided into survival group and non-survival group .Results Sixty -eight patients were divided into survival group ( n =54 ) and non-survival group ( n=35).There were no significantly differences in age , sex, primary disease, blood glucose concentration on admission , acute physiology and chronic health evaluation and sequential organ failure assessment between two groups (P>0.05).GLUmax, GLUdif, MAGE in survival group were significantly lower than those in non -survival group (P<0.05).Area under ROC of MAGE, GLUmax and GLUdif were 0.806, 0.787 and 0.769, respectively.With a cut-off value of 15.4 mmol/L, GLUmax had a sensitivity of 77.8% and a specificity of 83.3%.Conclusion Blood glucose concentration and blood glucose variability are important factors to 28-day survival rate in adults with complicated intra -abdominal infection after surgical operation .GLUmax during 24 hours admission to ICU is a good index to predict prognosis for adults with complicated intra -abdominal infection after surgical operation, and the cut-off value of GLUmax is 15.4 mmol/L.