中国危重病急救医学
中國危重病急救醫學
중국위중병급구의학
CHINESE CRITICAL CARE MEDICINE
2012年
11期
643-646
,共4页
刘朝晖%苏磊%吴金春%谭戬浩%廖银光%刘志峰
劉朝暉%囌磊%吳金春%譚戩浩%廖銀光%劉誌峰
류조휘%소뢰%오금춘%담전호%료은광%류지봉
多发伤%血糖变异性%血糖%预后
多髮傷%血糖變異性%血糖%預後
다발상%혈당변이성%혈당%예후
Trauma%Blood glucose variability%Blood glucose%Prognosis
目的 探讨血糖水平和血糖波动对多发伤患者预后的影响.方法 回顾性分析300例多发伤患者入住重症监护病房(ICU)72 h内平均血糖(GluAve)、血糖标准差(GluSD)、血糖变异率(GluCV).根据预后将患者分为存活组(249例)及死亡组(51例),比较两组间GluAve、GluSD、GluCV.将GluAve分为5个亚组(3.9 ～5.5、5.6 ～ 6.6、6.7～7.7、7.8～9.9、≥10.0 mmol/L)、GluCV分为4个亚组(＜15％、15％ ～ 30％、30％ ～ 50％、＞50％),分别分析不同亚组间院内病死率,并分析不同GluAve水平、GluCV亚组的病死率.采用多因素logistic回归分析多发伤患者死亡危险因素.结果 死亡组GluAve (mmol/L)、GluSD(mmol/L)、GluCV均高于存活组[11.31±4.38比8.50±3.40,2.85±1.94比1.87±1.67,(28.30±23.08)％比(20.90±13.70)％,均P＜0.05].随GluAve、GluCV逐渐上升,病死率也逐渐升高(x12=26.332、P=0.000,x22=65.522、P=0.000).在GluAve 7.8 ～9.9 mmol/L亚组中,GluCV＜15％亚组及GluCV ＞50％亚组的病死率分别为9.09％(3/33)与46.15％(6/13,P＜0.01),而GluAve≥10.0 mmol/L亚组内相应病死率分别为21.05％(4/19)和61.54％(8/13,P＜0.05).多因素logistic回归分析中,GluAve、GluCV为死亡危险因素[GluAve优势比(OR)=1.150,95％可信区间(95％CI)为(1.042,1.270),P=0.006; GluCV OR=1.022,95％CI为(0.999,1.040),P=0.040],而GluSD对死亡无影响.结论 GluAve、GluCV升高与多发伤死亡显著相关,控制血糖及血糖波动可能是减少多发伤死亡的重要策略之一.
目的 探討血糖水平和血糖波動對多髮傷患者預後的影響.方法 迴顧性分析300例多髮傷患者入住重癥鑑護病房(ICU)72 h內平均血糖(GluAve)、血糖標準差(GluSD)、血糖變異率(GluCV).根據預後將患者分為存活組(249例)及死亡組(51例),比較兩組間GluAve、GluSD、GluCV.將GluAve分為5箇亞組(3.9 ～5.5、5.6 ～ 6.6、6.7～7.7、7.8～9.9、≥10.0 mmol/L)、GluCV分為4箇亞組(＜15％、15％ ～ 30％、30％ ～ 50％、＞50％),分彆分析不同亞組間院內病死率,併分析不同GluAve水平、GluCV亞組的病死率.採用多因素logistic迴歸分析多髮傷患者死亡危險因素.結果 死亡組GluAve (mmol/L)、GluSD(mmol/L)、GluCV均高于存活組[11.31±4.38比8.50±3.40,2.85±1.94比1.87±1.67,(28.30±23.08)％比(20.90±13.70)％,均P＜0.05].隨GluAve、GluCV逐漸上升,病死率也逐漸升高(x12=26.332、P=0.000,x22=65.522、P=0.000).在GluAve 7.8 ～9.9 mmol/L亞組中,GluCV＜15％亞組及GluCV ＞50％亞組的病死率分彆為9.09％(3/33)與46.15％(6/13,P＜0.01),而GluAve≥10.0 mmol/L亞組內相應病死率分彆為21.05％(4/19)和61.54％(8/13,P＜0.05).多因素logistic迴歸分析中,GluAve、GluCV為死亡危險因素[GluAve優勢比(OR)=1.150,95％可信區間(95％CI)為(1.042,1.270),P=0.006; GluCV OR=1.022,95％CI為(0.999,1.040),P=0.040],而GluSD對死亡無影響.結論 GluAve、GluCV升高與多髮傷死亡顯著相關,控製血糖及血糖波動可能是減少多髮傷死亡的重要策略之一.
목적 탐토혈당수평화혈당파동대다발상환자예후적영향.방법 회고성분석300례다발상환자입주중증감호병방(ICU)72 h내평균혈당(GluAve)、혈당표준차(GluSD)、혈당변이솔(GluCV).근거예후장환자분위존활조(249례)급사망조(51례),비교량조간GluAve、GluSD、GluCV.장GluAve분위5개아조(3.9 ～5.5、5.6 ～ 6.6、6.7～7.7、7.8～9.9、≥10.0 mmol/L)、GluCV분위4개아조(＜15％、15％ ～ 30％、30％ ～ 50％、＞50％),분별분석불동아조간원내병사솔,병분석불동GluAve수평、GluCV아조적병사솔.채용다인소logistic회귀분석다발상환자사망위험인소.결과 사망조GluAve (mmol/L)、GluSD(mmol/L)、GluCV균고우존활조[11.31±4.38비8.50±3.40,2.85±1.94비1.87±1.67,(28.30±23.08)％비(20.90±13.70)％,균P＜0.05].수GluAve、GluCV축점상승,병사솔야축점승고(x12=26.332、P=0.000,x22=65.522、P=0.000).재GluAve 7.8 ～9.9 mmol/L아조중,GluCV＜15％아조급GluCV ＞50％아조적병사솔분별위9.09％(3/33)여46.15％(6/13,P＜0.01),이GluAve≥10.0 mmol/L아조내상응병사솔분별위21.05％(4/19)화61.54％(8/13,P＜0.05).다인소logistic회귀분석중,GluAve、GluCV위사망위험인소[GluAve우세비(OR)=1.150,95％가신구간(95％CI)위(1.042,1.270),P=0.006; GluCV OR=1.022,95％CI위(0.999,1.040),P=0.040],이GluSD대사망무영향.결론 GluAve、GluCV승고여다발상사망현저상관,공제혈당급혈당파동가능시감소다발상사망적중요책략지일.
Objective To investigate the effect of glucose level,variability on the prognosis of traumatic patients.Methods A retrospective study involving 300 traumatic patients admitted to intensive care unit (ICU)was performed.The average glucose (GluAve),gluose standard deviation (GluSD) and glucose coefficient of variation (GluCV) during the first 72 hours were calculated.Patients were divided into survivor group (n =249) and non-survivor group (n=51) based on outcomes.The GluAve,GluSD and GluCV were compared between the two groups.Patients were allocated into five subgroups based on GluAve (3.9-5.5,5.6-6.6,6.7-7.7,7.8-9.9,≥10.0 mmol/L) as well as four subgroups on GluCV (＜ 15％,15％-30％,30％-50％,＞50％).The mortality in hospital was compared among the different subgroups and the different GluCV in the same level of GluAve subgroups,respectively.Multifactor logistic regression was used to determine the risk factor of hospital death.Results The levels of GluAve (mmol/L),GluSD (mmol/L),GluCV of non-survivor group were higher than those of survivor group [11.31 ±4.38 vs.8.50 ± 3.40,2.85 ± 1.94 vs.1.87 ± 1.67,(28.30 ± 23.08) ％ vs.(20.90 ± 13.70)％,all P＜0.05].With the gradual increasement of GluAve and GluCV level,the mortality was raised accordingly (x12=26.332,P=0.000; x22=65.522,P=0.000).In the subgroup of GluAve 7.8-9.9 mmol/L,the mortality was 9.09％ (3/33) with GluCV ＜ 15％ versus 46.15％ (6/13) with GluCV ＞ 50％ (P＜0.01) respectively,and in the subgroup of GluAve ≥ 10.0 mmol/L,the mortality corresponding rates were 21.05％ (4/19) with GluCV ＜ 15％ and 61.54％ (8/13) with GluCV ＞ 50％ (P＜0.05).The multivariable logistic regression analysis demonstrated that GluAve and GluCV were risk factors of mortality [GluAve odds ratio (OR)=1.150,95％ confidence interval (95％CI) was 1.042 to 1.270,P=0.006; GluCV OR=1.022,95％CI was 0.999 to 1.040,P=0.040],GluSD had no effect on mortality.Conclusions The increase in GluAve and GluCV in traumatic patients are significantly correlated with mortality.Control the level and the variability of blood glucose might be an important aspect of the multiple trauma death reduction.
