中华神经科杂志
中華神經科雜誌
중화신경과잡지
Chinese Journal of Neurology
2012年
10期
734-738
,共5页
血糖%危重病%死亡
血糖%危重病%死亡
혈당%위중병%사망
Blood glucose%Critical illness%Death
目的 探讨血糖变异性与神经内科危重症患者死亡的相关性.方法 回顾性研究231例神经内科重症监护病房患者的临床资料.病例分为存活组(n=190)和死亡组(n=41).记录每例患者的性别、年龄、是否需要机械通气、急性生理与慢性健康评估Ⅱ(APACHEⅡ)评分等基线资料,记录所有患者的血糖值.以标准差、变异系数、最大连续变化、平均血糖漂移幅度等指标来衡量血糖变异性.用Logistic回归模型来分析血糖变异性与死亡的相关性,并用受试者工作特征(ROC)曲线对各血糖变异性指标在预测病死率上的应用价值进行评价.结果 血糖变异性、APACHEⅡ评分(不含年龄)、机械通气与死亡相关(OR=4.959、1.444、5.472,95％ CI 2.015 ～ 12.202、1.240～1.681、1.455 ～ 20.574,P=0.000、0.000、0.012).血糖标准差及APACHEⅡ评分(不含年龄)预测病死率价值较高(ROC曲线下面积分别为0.910、0.957),且两者预测病死率的价值相同(Z=1.396,P=0.163)；变异系数、最大连续变化、平均血糖漂移幅度预测病死率价值中等(曲线下面积=0.847、0.856、0.872).结论 血糖变异性与神经内科危重症患者的死亡密切相关.
目的 探討血糖變異性與神經內科危重癥患者死亡的相關性.方法 迴顧性研究231例神經內科重癥鑑護病房患者的臨床資料.病例分為存活組(n=190)和死亡組(n=41).記錄每例患者的性彆、年齡、是否需要機械通氣、急性生理與慢性健康評估Ⅱ(APACHEⅡ)評分等基線資料,記錄所有患者的血糖值.以標準差、變異繫數、最大連續變化、平均血糖漂移幅度等指標來衡量血糖變異性.用Logistic迴歸模型來分析血糖變異性與死亡的相關性,併用受試者工作特徵(ROC)麯線對各血糖變異性指標在預測病死率上的應用價值進行評價.結果 血糖變異性、APACHEⅡ評分(不含年齡)、機械通氣與死亡相關(OR=4.959、1.444、5.472,95％ CI 2.015 ～ 12.202、1.240～1.681、1.455 ～ 20.574,P=0.000、0.000、0.012).血糖標準差及APACHEⅡ評分(不含年齡)預測病死率價值較高(ROC麯線下麵積分彆為0.910、0.957),且兩者預測病死率的價值相同(Z=1.396,P=0.163)；變異繫數、最大連續變化、平均血糖漂移幅度預測病死率價值中等(麯線下麵積=0.847、0.856、0.872).結論 血糖變異性與神經內科危重癥患者的死亡密切相關.
목적 탐토혈당변이성여신경내과위중증환자사망적상관성.방법 회고성연구231례신경내과중증감호병방환자적림상자료.병례분위존활조(n=190)화사망조(n=41).기록매례환자적성별、년령、시부수요궤계통기、급성생리여만성건강평고Ⅱ(APACHEⅡ)평분등기선자료,기록소유환자적혈당치.이표준차、변이계수、최대련속변화、평균혈당표이폭도등지표래형량혈당변이성.용Logistic회귀모형래분석혈당변이성여사망적상관성,병용수시자공작특정(ROC)곡선대각혈당변이성지표재예측병사솔상적응용개치진행평개.결과 혈당변이성、APACHEⅡ평분(불함년령)、궤계통기여사망상관(OR=4.959、1.444、5.472,95％ CI 2.015 ～ 12.202、1.240～1.681、1.455 ～ 20.574,P=0.000、0.000、0.012).혈당표준차급APACHEⅡ평분(불함년령)예측병사솔개치교고(ROC곡선하면적분별위0.910、0.957),차량자예측병사솔적개치상동(Z=1.396,P=0.163)；변이계수、최대련속변화、평균혈당표이폭도예측병사솔개치중등(곡선하면적=0.847、0.856、0.872).결론 혈당변이성여신경내과위중증환자적사망밀절상관.
Objective To explore the correlation between the glucose variability and the death of critically ill patients in neurology department.Methods Clinical characteristics of 231 patients admitted to neurointensive care unit (N-ICU) were analyzed retrospectively.The patients were divided into two groups:survival group(n =190)and death group (n =41).The baseline data,such as gender,age,mechanical ventilation,acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score were recorded.All data of blood glucose measured during hospitalization in N-ICU were collected.Standard deviation (SD),coefficient of variability (CV),maximum successive change and mean amplitude of glycemic excursions (MAGE) were used as glucose variability index.Logistic regression analysis was used to study the association between the glucose variability and the death.Receiver operating characteristic (ROC) curve was adopted to evaluate the application value of each glucose variability index on predicting mortality.Results Glucose variability,APACHE Ⅱ score (deleting the age component) and mechanical ventilation were significantly correlated with death (OR =4.959,1.444,5.472 ; 95％ CI 2.015 ～ 12.202,1.240 ～ 1.681,1.455 ～20.574;P =0.000,0.000,0.012).The predictive value was high and same when using SD and APACHE Ⅱ score (deleting the age component) as predictor (area under the ROC curve =0.910,0.957 ;Z =1.396,P =0.163).The application value of CV,maximum successive change and MAGE was moderate (area under the curve =0.847,0.856,0.872).Conclusion There is significant association between the glucose variability and the death of critically ill patients in neurology department.
