CAJ | 학술논문

目的：研究血糖波动对危重外伤患者生存状况的影响。方法选取2012年12月到2014年2月入住急诊重症监护病房（ICU）的60例危重外伤患者为研究对象，观察并记录第一个24 h 的血糖情况，每隔2 h 检测一次，计算患者血糖的平均值（MEAN）、标准差（SD）、变异系数（CV）、血糖不稳定指数（GLI）、日最大血糖波动值（LAGE）以及28 d病死率。根据患者的 MEAN 和 GLI 的中位数把患者分为高 MEAN +高 GLI 组（A 组，6例），高 MEAN +低 GLI 组（B 组，10例），低 MEAN +高 GLI 组（C 组，12例），低 MEAN +低 GLI 组（D 组，32例），观察并比较各组患者的血糖变化水平及生存状况。结果四组患者的血糖变化指标差异均有统计学意义（ P ﹤0.05），血糖 MEAN，C、D 组较低，A、B 组较高；血糖波动水平 SD、CV、GLI、LAGE 等 B、D 组较低，A、C 组较高；APACHEⅡ评分 D 组最低，A 组最高，差异均有统计学意义（ P ﹤0.05）；高血糖发生率以 A、B 组较高，D 组最低；低血糖发生率以 A 组最高，B、D 组较低；差异均有统计学意义（ P ﹤0.05）；四组患者 ICU 住院时间、28 d 病死率差异有统计学意义（ P ﹤0.05），ICU 入住时间 D 组时间最短，效果较好；28 d 病死率 D 组最低，A 组最高，总体死亡率为8.3％。结论较低血糖波动患者的高血糖和低血糖的发生率较低，同时患者的病死率的也较低。所以在临床治疗中应尽量降低患者的血糖波动，必要时可给予降糖治疗。
목적：연구혈당파동대위중외상환자생존상황적영향。방법선취2012년12월도2014년2월입주급진중증감호병방（ICU）적60례위중외상환자위연구대상，관찰병기록제일개24 h 적혈당정황，매격2 h 검측일차，계산환자혈당적평균치（MEAN）、표준차（SD）、변이계수（CV）、혈당불은정지수（GLI）、일최대혈당파동치（LAGE）이급28 d병사솔。근거환자적 MEAN 화 GLI 적중위수파환자분위고 MEAN +고 GLI 조（A 조，6례），고 MEAN +저 GLI 조（B 조，10례），저 MEAN +고 GLI 조（C 조，12례），저 MEAN +저 GLI 조（D 조，32례），관찰병비교각조환자적혈당변화수평급생존상황。결과사조환자적혈당변화지표차이균유통계학의의（ P ﹤0.05），혈당 MEAN，C、D 조교저，A、B 조교고；혈당파동수평 SD、CV、GLI、LAGE 등 B、D 조교저，A、C 조교고；APACHEⅡ평분 D 조최저，A 조최고，차이균유통계학의의（ P ﹤0.05）；고혈당발생솔이 A、B 조교고，D 조최저；저혈당발생솔이 A 조최고，B、D 조교저；차이균유통계학의의（ P ﹤0.05）；사조환자 ICU 주원시간、28 d 병사솔차이유통계학의의（ P ﹤0.05），ICU 입주시간 D 조시간최단，효과교호；28 d 병사솔 D 조최저，A 조최고，총체사망솔위8.3％。결론교저혈당파동환자적고혈당화저혈당적발생솔교저，동시환자적병사솔적야교저。소이재림상치료중응진량강저환자적혈당파동，필요시가급여강당치료。
Objective To explore the impact on survival of fluctuations in blood glucose in critically ill trauma patients. Methods 60 patients in critically ill trauma patients were selected between December 2012 and February 2014 in emergency intensive care unit. These patients were implemented daily sedation interruption. The first 24 h of blood sugar every 2 h were observed and recorded. The average of blood glucose (MEAN),standard deviation(SD),coefficient of variation(CV),glycemic instability index(GLI),the maximum daily fluctuations in blood glucose values(LAGE)and 28 d mortality were calculated. According to the patientˊs MEAN and GLI median,the patients were divided into high MEAN + high GLI group(A,6 cases),high MEAN + low GLI group(group B,10 patients),low MEAN + high GLI group(group C,12 pa-tients),low MEAN + low GLI group(D group,32 cases). The changes in blood sugar levels and survival of patients in each group were ob-served and compared. Results Blood glucose targets of four groups of patients were statistically significant( P ﹤ 0. 05),glucose MEAN,C,D group are lower,A,B group are higher. The fluctuations in blood sugar levels SD,CV,GLI,LAGE such as B,D group are lower,and A,C group are higher. The APACHEⅡ score in group D is lowest,group A is the highest,the difference was statistically significant( P ﹤ 0. 05). High incidence of hypoglycemia in A group,the group B is higher,the D group is lowest. The hypoglycemia rate in A group is the highest. B,D group is low;the differences were statistically significant( P ﹤ 0. 05). Four patients stay in ICU,28 d mortality difference was statistically signifi-cant( P ﹤ 0. 05). ICU stay time D group is shortest;28 d fatality rate in group D is lowest. The overall mortality rate in A group is highest with 8. 3% . Conclusion Lower incidence of low blood glucose fluctuations was observed in patients with high blood sugar and low blood sugar,while the prognosis of mortality is low. Therefore,patients should be tried to reduce blood sugar fluctuations,and hypoglycemic therapy may be given if necessary in the clinical treatment.