ICU顱腦疾病患者血糖波動與短期預后及危重程度的相關性研究

王翠云 劉念 申小俠

摘要：目的 ?探討重癥監護病房（ICU）顱腦疾病患者血糖波動與短期預后、危重程度的相關性。方法 ?選擇2014年1月～2015年11月我院97例APACHEⅡ評分≥15分、入ICU時間≥3 d的顱腦疾病患者作為研究對象，監測入住ICU 72 h內血糖值，記錄初始血糖（GLUadm）、平均血糖（GLUave）、血糖標準差（GLUsd）、血糖變異系數（GLUcv）。根據患者28 d預后情況分為存活組（67例）與死亡組（30例），比較兩組間APACHEⅡ評分、GLUadm、GLUave、GLUsd、GLUcv水平，分析血糖各指標與APACHEⅡ評分的相關性。結果 ?死亡組患者APACHEⅡ評分高于存活組，差異有統計學意義（P<0.05）;兩組GLUadm、GLUave水平比較，差異無統計學意義（P>0.05）;死亡組GLUsd、GLUcv水平高于存活組，差異有統計學意義（P<0.05）;GLUave與APACHEⅡ評分無相關性（P>0.05）;GLUadm、GLUsd、GLUcv與APACHEⅡ評分均呈正相關（P<0.05）。結論 ?ICU顱腦疾病患者血糖波動與短期預后密切相關，與APACHEⅡ評分呈正相關;血糖波動水平對判斷患者危重程度和短期預后有重要意義。

關鍵詞：顱腦疾病;血糖波動;APACHEⅡ評分;預后

中圖分類號：R651.15 ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? 文獻標識碼：A ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? DOI：10.3969/j.issn.1006-1959.2020.17.055

文章編號：1006-1959（2020）17-0179-03

Abstract：Objective To explore the correlation between blood glucose fluctuations and short-term prognosis and criticality in patients with craniocerebral diseases in the intensive care unit （ICU）.Methods ?From January 2014 to November 2015， 97 patients with craniocerebral disease with APACHE II score ≥15 and ICU admission time ≥3 d were selected as the research objects. The blood glucose level within 72 h of admission to the ICU was monitored and the initial blood glucose was recorded （GLUadm ）， average blood glucose （GLUave）， blood glucose standard deviation （GLUsd）， blood glucose coefficient of variation （GLUcv）. Patients were divided into survival group （67 cases） and death group （30 cases） according to the 28-day prognosis. The APACHEⅡ score， GLUadm， GLUave， GLUsd， and GLUcv levels were compared between the two groups， and the correlation between blood glucose indicators and APACHEⅡ score was analyzed.Results ?The APACHE Ⅱ score of the death group was higher than that of the survival group，the difference was statistically significant （P<0.05）; the difference between the two groups of GLUadm and GLUave levels was not statistically significant （P>0.05）; the GLUsd and GLUcv levels of the death group were higher than those of the survival group，the difference was statistically significant （P<0.05）; GLUave was not correlated with APACHEⅡ score （P>0.05）; GLUadm， GLUsd， GLUcv and APACHEⅡ score were all positively correlated （P<0.05）.Conclusion ?Blood glucose fluctuations in ICU patients with craniocerebral diseases were closely related to the short-term prognosis， and were positively correlated with the APACHE Ⅱ score; blood glucose fluctuations were of great significance in judging the criticality and short-term prognosis of patients.

Key words：Craniocerebral disease;Blood glucose fluctuation;APACHEⅡ score;Prognosis

研究發現[1，2]，高血糖不僅會對患者的預后產生不良影響，血糖波動同樣會給患者機體帶來很大的損傷，并且不亞于高血糖對其的影響。顱腦疾病患者因應激反應、下丘腦-垂體系統受損和創傷后存在胰島素抵抗現象等引起血糖升高或波動[3]，單純應用血糖值并不能很好地反映患者的預后。國外已有較多研究證實血糖波動與危重癥患者預后相關[2，4，5]，但國內研究較少，尤其是有關顱腦疾病患者血糖波動與預后關系的研究較少。本研究采用72 h平均血糖（GLUave）作為血糖平均水平指標，血糖標準差（GLUsd）和血糖變異系數（GLUcv）作為血糖波動的指標，采用急性生理學及慢性健康狀況評估Ⅱ（APACHE-Ⅱ）評分作為反映危重癥病情嚴重程度的指標，旨在探討重癥監護病房（Intensive Care Unit，ICU）顱腦疾病患者血糖波動與短期預后、危重程度的相關性，先報道如下。……