夏云松,刘旭,毕红英,付建宇,方慧,唐艳,王迪芬
XIA Yunsong,LIU Xu,BI Hongying,FU Jianyu,FANG Hui,TANG Yan,WANG Difen

• 1:贵州医科大学重症医学教研室
• 2:贵州医科大学
• 3:贵州医科大学附属医院重症医学科

摘要(Abstract)：

目的分析重症患者血糖、血糖波动性与预后的相关性。方法收集113例符合标准的重症病人72 h内的血糖值,分别统计平均血糖(MEAN)、血糖标准差(SD)、血糖变异系数(CV)、平均绝对血糖改变值(MAG)、血糖不稳定指数(GLI),根据28 d患者预后将其分为存活组和死亡组,比较两组患者一般资料及血糖相关指标的差异,应用受试者工作特征曲线(ROC)曲线下面积(AUC)评价急性生理与慢性健康评分Ⅱ(APACHEⅡ)和血糖相关指标对患者28 d预后的判断价值;根据GLI水平将患者分为四组,比较各组患者28 d病死率的差异;以MEAN为标准,从高到低将患者分成M1、M2、M3组,比较各组患者28 d病死率、一般临床资料及血糖波动指标的差异。结果与存活组相比,死亡组的APACHEⅡ评分、呼吸机使用时间、MEAN、SD、CV、MAG、GLI均升高(P<0.05),两组患者住ICU时间差异无统计学意义(P> 0.05);SD、CV、MAG、GLI的AUC高于APACHEⅡ评分及MEAN的AUC(P<0.05);GLI更高的患者病死率更高(P<0.05);与M2和M3组患者比较,M1组患者有更高的血糖波动指标、更长的呼吸机使用时间、更高的28 d病死率(P<0.05);M1、M2和M3组患者病情严重程度和住ICU时间差异无统计学意义(P> 0.05)。结论血糖波动性与重症患者预后相关。
Objective To analyze the correlation between blood glucose,blood glucose fluctuation and prognosis in critically ill patients.Methods The blood glucose levels within 72 h of 113 critically ill patients were collected.Statistics was made on the mean blood glucose(MEAN),standard deviation of blood glucose(SD),blood glucose variability coefficient(CV),mean absolute blood glucose change(MAG),and the glycemic lability index(GLI).According to the prognosis after 28 days,they were divided into survival group and death group.The differences of general data and blood glucose related indexes between the two groups were compared.Receiver operating characteristic(ROC) curve was applied to evaluate the judgment values of APACHE Ⅱ score and blood glucoserelated indexes on the prognosis after 28 d.Then the patients were divided into four groups according to the GLI level,and the difference of 28 d mortality between the four groups was compared.Then7.8 mmol/L and 10.0 mmol/L were set as the boundary values and the patients were divided into M1,M2,and M3 groups from high to low MEAN.The 28 d mortality,general clinical data and blood glucose fluctuation indexes of each group were compared.Results Compared with those in survival group,APACHE Ⅱ score,service time of ventilator,MEAN,SD,CV,MAG,and GLI of patients in the death group were significantly higher(P <0.05).There was no significant difference in the length of stay in ICU between the two groups(P>0.05).The AUC of SD,CV,MAG,and GLI were higher than those of APACHE Ⅱ and MEAN(P <0.05);Patients with higher GLI have higher mortality(P <0.05);Compared with other two groups,the M1 group had higher blood glucose variability index and longer service time of ventilator(P <0.05),and the highest 28 d mortality(P <0.05).There was no significant difference in severity of illness and length of stay in ICU among M1,M2,and M3 groups(P>0.05).Conclusion Blood glucose variability is associated with prognosis in critically ill patients.

关键词(KeyWords)： 平均血糖;血糖不稳定指数;血糖标准差;血糖变异系数;平均绝对血糖改变值;重症患者;预后
blood glucose;prognosis;mean blood glucose;standard deviation of blood glucose;blood glucose variability coefficient;mean absolute blood glucose change;critically ill patients

Abstract:

Keywords:

基金项目(Foundation): 贵州省科技计划项目[黔科合LH字（2016）7249];; 国家自然科学青年基金（81701958）;; 吴阶平医学基金会临床科研专项资助基金（320.6750.18001）

作者(Author): 夏云松,刘旭,毕红英,付建宇,方慧,唐艳,王迪芬
XIA Yunsong,LIU Xu,BI Hongying,FU Jianyu,FANG Hui,TANG Yan,WANG Difen

DOI: 10.19367/j.cnki.2096-8388.2021.11.012

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