摘要
目的探讨短期强化血糖控制对重症感染合并应激性高血糖患者血糖变异性(GV)及预后的影响。方法收集重症感染合并应激性高血糖患者86例,按随机数字表法分为强化组(血糖控制在4.4~6.1 mmol/L)和对照组(血糖控制在8.0~10.0 mmol/L)各43例。观察2组入院第1、3、7天T细胞亚群(CD_4^+、CD_8^+及CD_4^+/CD_8^+)及空腹血糖(FPG)的变化,比较2组患者GV、低血糖事件及28 d病死率,采用多因素Logistic回归分析GV与预后的相关性。结果强化组第3、7天,CD_4^+、GD_4^+/CD_8^+均较第1天显著升高(第3天t=2.42、2.06,第7天t=4.85、4.69,P<0.05),且明显高于同期对照组(第3天t=2.71、2.05,第7天t=5.64、2.32,P<0.05);强化组血糖达标时间、入院第3天和第7天FPG、GV、28 d病死率均显著低于对照组(t=7.28、23.07、24.31、0.18、χ~2=5.47,P<0.05);2组入院第1天FPG、低血糖发生率比较,差异均无统计学意义(t=1.82,0.54,P>0.05);与存活者比较,死亡者血糖达标时间明显延长,入院第3天、第7天FPG、APACHEⅡ评分及GV明显升高(OR=1.705、1.889、1.924、1.436、2.018,P<0.05);Logistic回归分析显示,入院时APACHEⅡ评分(OR=1.99,95%CI1.66~2.38,P<0.01),GV(OR=4.049,95%C 1.870~8.750,P<0.01)是重症感染合并应激性高血糖患者死亡的独立危险因素。结论对于重症感染合并应激性高血糖患者,短期强化血糖控制可有效控制感染,增强免疫功能,降低血糖波动,改善预后。
Objective To investigate the impact of short-term intensive glucose control on severe infections in pa-tients with stress hyperglycemia merger glucose variability （ GV） and prognosis.Methods Eighty-six patients with severe in-fection complicated stress hyperglycemia were randomly divided into intensive group （ blood glucose were 4.4-6.1 mmol /L） and the control group （8.0-10.0 mmol/L）, 43 cases in each group.Observation group after admission’s 1,3,7 day’s T cell subsets （ CD4＋, CD8＋and CD4＋/CD8＋） and fasting plasma glucose （ FPG） changes were compared between the 2 groups, hypoglycemia and 28 days’ mortality analysis and prognosis were compared with multi-factor Logistic regression.Results In-tensive group’s 3,7 days’ CD4＋, CD4＋/CD8＋were increased than those of the first day （at d3, t =2.42, t =2.06, at d7, t =4.85, t =4.69, P 〈0.05）, which were significantly higher than the control group （at d3, t =2.71, t =2.05, at d7, t =5.64, t =2.32, P 〈0.05）;blood glucose reached the normal level time of intensive group, after admission’s 3rd and 7th days’ FPG, GV, 28 days’ mortality was significantly lower than the control group （ t =7.28, t =23.07, t =24.31, t =0.18, t =5.47, P 〈0.05）;2 group’s 1st day’s FPG, the incidence of hypoglycemia’s differences did not show statis-tically significant differences （ t =1.82, t =0.54, P 〉0.05）; compared with survivors, death patients’ glucose standard time was prolonged, the 3rd days, 7th days’ FPG, APACHE II score and GV significantly higher （ OR =1.705, OR =1.889, OR =1.924, OR =1.436, OR =2.018, P 〈0.05）;Logistic regression analysis showed that APACHE II and GV were independent risk factor for severe infection with stress hyperglycemia in death patients （ OR=1.990,95%CI 1.66 -2.38, P 〈0.01;OR =4.049,95% CI 1.870-8.750, P 〈0.01）.Conclusion For patients with severe infections and stress hyperglycemia, short-term intensive blood glucose control can effectively control the infection, enhance immune func-tion, reduce blood sugar fluctuations and improve prognosis.
出处
《疑难病杂志》
CAS
2015年第6期582-585,共4页
Chinese Journal of Difficult and Complicated Cases
关键词
强化血糖控制
重症感染
应激性高血糖
血糖波动
预后
Intensive glucose control
Severe infection
Stress hyperglycemia
Blood sugar fluctuations
Prognosis
