摘要
目的探讨血糖波动对重型创伤性颅脑损伤（STBI）患者预后的影响。方法回顾性分析64例STBI患者的临床资料，记录入住重症监护病房（ICU）72h内平均血糖（GluAve）、血糖标准差（GluSD）、血糖变异系数（GluCV）、是否需要机械通气、是否手术治疗，以及急性生理学号漫性健康评分系统Ⅱ（APACHE1I）评分、格拉斯哥昏迷评分（GCS）等资料。根据28d预后将患者分为存活组（38例）及死亡组（26例），比较两组间GluAve、GluSD、GluCV的差异；根据GluAve水平将患者分为3个亚组（〈6．0mmol／L、6．0—10．0mmot／L和〉10．0mmol／L组），根据GluCV将患者分为4个亚组（〈15％、15％～30％、30％～50％、〉50％），比较不同亚组间病死率。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。结果死亡组APACHEI／评分及GluAve、GluSD、GluCV均明显高于存活组（P〈0．05）；GCS评分明显低于存活组（P〈0．05），而机械通气及手术比例比较，差异无统计学意义（P〉0．05）。随着GluAve、GluCV逐渐增高，患者28d病死率也逐渐增高（xi=6．841，P=0．033；x；=11．685，P：0．009）。ROC曲线显示，GluSD、GluCV预测病死率的价值较高（ROC曲线下面积分别为0．823、0．753），且两者与APACHElI评分预测病死率的价值相似（Z=0．432、1．279，P=0．665、0．201）。结论高血糖、血糖波动与STBI患者预后密切相关，且血糖变异性可能与APACHE1I评分一样能够较好地预测病死率。
Objective To investigate the relationship between blood glucose fluctuation and the prognosis of severe traumatic brain injury patients. Methods A retrospective study involving 64 severe traumatic brain injury patients admitted to intensive care unit （ICU） was performed. The average glucose （GluAve） , glucose standard deviation （GluSD） and glucose coefficient of variation （GluCV） during the first 72 hours were monitored. Data including mechanical ventilation, operation, acute physiology and chronic health evaluation Ⅱ （ APACHE Ⅱ ） score and glasgow coma scale （ GCS ） score were also recorded. According to the 28 - day outcome after admission, patients were divided into survivor group （n =38） and non- survivor group （n =26）. The values of GluAve, GluSD and GluCV were compared between the two groups. Patients were allocated into three subgroups based on GluAve （ 〈 6.0,6.0 10.0, 〉10.0 mmol/L）as well as four subgroups on GluCV （ 〈 15%, 15% - 30% ,30% -50%, 〉 50% ）. The mortality was compared among the different subgroups. Receiver operating characteristic （ROC） curve was adopted to evaluate the application value of each blood glucose variability index on predicting mortality. Results The levels of APACHE Ⅱ , GluAve, GluSD and GluCV in non - survivor group were significantly higher than that in survivor group （ P 〈 0.05 ）. The level of GCS in survivor group was significantly higher than that in non - survivor group （ P 〈 0.05 ）. But there was no significant difference in ratio of mechanical ventilation and operation （ P 〉 0.05 ）. With the gradual increase of GluAve and GIuCV level, the mortality was raised accordingly （X 2 = 6. 841, P = 0. 033 ; X22 = 11. 685, P = 0. 009 ）. The predictive value was high when using GluSD and GluCV as predictor （ areas under the ROC curve = 0.823, 0. 753 ） and was similar to APACHE Ⅱ score （ Z = 0. 432, 1. 279 ; P = 0. 665, 0.201 ）. Conclusion Hyperglycemia and glucose fluctuation are firmly associated with mortality in patients with STBI and blood glucose variability may predict mortality as good as APACHE Ⅱ score.
出处
《中国急救医学》
CAS
CSCD
北大核心
2017年第7期612-616,共5页
Chinese Journal of Critical Care Medicine
