摘要
目的探讨危重症患者相对性低血糖(RHG)的发生率及RHG对患者临床预后的影响。方法选取台州恩泽医疗中心(集团)恩泽医院、路桥医院重症监护病房(ICU)收治的成年患者93例,记录患者入院一般信息、器官功能评分及预后指标,并记录入院后72h的血糖水平至少12次。根据入院时检测的糖化血红蛋白水平评估病前平均血糖水平,每次低于该水平超过30%则定义为单个RHG事件。发生RHG事件的患者为观察组,未发生RHG事件的患者为对照组。根据RHG发生次数进行分级,Ⅰ级为1~2个RHG事件,Ⅱ级为3~4个RHG事件,Ⅲ级为>4个RHG事件。通过RHG次数及血糖水平来评估其对预后的影响。结果 93例患者中,发生RHG事件35例,发生率为37.6%。其中Ⅰ级16例,Ⅱ级13例,Ⅲ级6例。两组患者入院时的临床资料、疾病严重程度等方面比较差异均无统计学意义(均P>0.05)。观察组患者住院病死率、多器官功能障碍综合征发生率、入院3d内昏迷程度均高于对照组,差异均有统计学意义(均P<0.05)。观察组患者住院时间和住ICU时间均长于对照组,差异均有统计学意义(均P<0.05),其中RHG Ⅲ级患者住ICU时间明显高于其他患者。结论 RHG在危重症患者中发生率较高,且与患者预后密切相关。
Objective To investigate the incidence and clinical significance of relative hypoglycemia(RHG) in the critically ill patients.Methods Clinical data of 93 adult patients who were admitted to the intensive care unit of Taizhou Enze Hospital and Luqiao Hospital were retrospectively analyzed.Patients who stayed in ICU for more than 72 h with at least 12 blood glucose recordings were included for analysis.A glucose level>30% below the average value estimated according to the HbA1 C at admission was defined as RHG event.According to the number of RHG events during the first 72 h of ICU stay,patients with 1-2 events were defined as grade Ⅰ,with 3-4 as grade Ⅱ and with>4 as grade Ⅲ.The outcome was compared between patients with or without RHG and among patients with different number of events of RHG.Results RHG was detected in 35 patients with an overall incidence of 3 7.6%.There were 16 cases of grade Ⅰ,13 cases of grade Ⅱ and 6 cases of grade Ⅲ.Patients with or without RHG showed similar severity at admission.However,patients with RHG had an increased mortality,higher incidence rate of multiple organ dysfunction syndrome and higher Glasgow Coma Scale scores(all P<0.05).Besides,longer ICU and hospital stay were also observed in RHG patients(both P<0.05),especially in grade Ⅲ patients.Conclusion In conclusion,RHG is a common finding in critically ill patient and is clo s ely associated with worse clinical outcome.
作者
赵辉
吴慧娟
陈清清
郑贞苍
ZHAO Hui;WU Huijuan;CHEN Qingqing(Department of Critical Care Medicine,Taizhou Enze Medical Center Group Enze Hospital,Taizhou 318050,China)
出处
《浙江医学》
CAS
2020年第5期441-444,449,共5页
Zhejiang Medical Journal
基金
台州市科技计划项目(1701KY58)
台州市路桥区科技计划项目(2019A23003)。
关键词
低血糖
危重症
预后
Hypoglycemia
Critical illness
Prognosis
