本文關鍵詞：血糖相關指標與重癥患者預后的相關性　出處：《貴州醫(yī)科大學》2017年碩士論文　論文類型：學位論文

  更多相關文章： 血糖 平均血糖 血糖標準差 血糖變異系數(shù) 平均絕對血糖改變值 血糖不穩(wěn)定指數(shù) 重癥患者 預后

【摘要】：目的:分析探討重癥患者平均血糖及血糖波動性與預后的相關性,同時將平均血糖及血糖波動性控制在一個相對合理的范圍,以指導重癥患者血糖的合理控制。方法:本研究是一項觀察性研究,選取2016年1月~2016年12月入住貴州醫(yī)科大學重癥醫(yī)學科并符合本次研究納入和排除標準的患者,根據(jù)不同的指標統(tǒng)計分析如下:其一,根據(jù)患者28d預后分成存活組和死亡組,比較兩組患者一般臨床資料及血糖相關指標的差異;其二,應用感受性曲線(ROC曲線)評價APACHE II評分與血糖相關指標對28d預后的價值;其三,統(tǒng)計反應血糖波動性的指標——血糖不穩(wěn)定指數(shù)(GLI),根據(jù)GLI的四分位數(shù)(1.09、6.66、13.58、26.49、206.00)將患者分為四組,即G1組:GLI在0%~25%(1.09(mmol/L)2/h/d≤GLI≤6.66(mmol/L)2/h/d)區(qū)間,G2組:GLI在26%~50%(6.66(mmol/L)2/h/dGLI≤13.58(mmol/L)2/h/d)區(qū)間,G3組:GLI在51%~75%(13.58(mmol/L)2/h/dGLI≤26.49(mmol/L)2/h/d)區(qū)間,G4組:GLI在76%~100%(26.4(mmol/L)2/h/d9GLI≤206.00(mmol/L)2/h/d)區(qū)間,分別比較上述各組之間患者APACHE II評分、平均血糖(BGmean)、28d病死率、住ICU時間及呼吸機使用情況的差異;其四,以平均血糖7.8mmol/L、10.0mmol/L為界,將患者分成三組,即Q1組:BGmean10.0mmol/L,Q2組:7.8mmol/L≤BGmean≤10.0mmol/L,Q3組:BGmean7.8mmol/L,分別比較上述三組間患者28d病死率、一般臨床資料及血糖波動指標的差異;其五,以BGmean的中位數(shù)(9.88mmol/L)為界,將BGmean分為高BGmean組(BGmean中位數(shù))和低BGmean組(BGmean≤中位數(shù)),同時以GLI的中位數(shù)(13.58(mmol/L)2/h/d)為界,將GLI分為高GLI組(GLI中位數(shù))和低GLI組(GLI≤中位數(shù)),聯(lián)合上述兩個指標,同時滿足低BGmean、低GLI的病人記為低BGmean+低GLI組,同時滿足高BGmean、低GLI的病人記為高BGmean+低GLI組,同時滿足低BGmean、高GLI的病人記為低BGmean+高GLI組,同時滿足高BGmean、高GLI的病人記為高BGmean+高GLI組,分別比較上述四組患者一般臨床資料及短期病死率的差異。結(jié)果:(1)死亡組患者APACHE II評分、呼吸機使用時間、平均血糖(BGmean)、血糖不穩(wěn)定指數(shù)(GLI)、血糖標準差(BGSD)、血糖變異系數(shù)(BGCV)、平均絕對血糖改變值(MAG)均較存活組高,差異均具有顯著統(tǒng)計學意義(P0.05),兩組患者年齡、ICU停留時間差異無顯著統(tǒng)計學意義(P0.05)。(2)APACHE II評分、BGmean、BGSD、BGCV、GLI、MAG對重癥患者28d病死率的判斷價值,ROC曲線下面積依次為0.627、0.677、0.780、0.758、0.806、0.799;(3)根據(jù)所有患者GLI的四分位數(shù)將患者分為四組,結(jié)果顯示G1組患者BGmean最低,G4組BGmean最高,差異有顯著統(tǒng)計學意義(P0.05),四組患者ICU停留時間差異無顯著統(tǒng)計學意義(P0.05),G4組患者呼吸機使用時間最長,其余三組差異無顯著統(tǒng)計學意義(P0.05)。28d病死率G4組患者最高,G1組與G2組、G2組與G3組28d病死率差異無顯著統(tǒng)計學意義(P0.05),G1組與G3組患者28d病死率差異有顯著統(tǒng)計學意義(P0.05);(4)根據(jù)平均血糖7.8mmol/L、10.0mmol/L,將患者分為三組,Q1組與Q2組BGmean、BGSD、BGCV、GLI、MAG及呼吸機使用時間差異有顯著統(tǒng)計學意義(P0.05),其余指標差異無顯著統(tǒng)計學意義(P0.05);Q2組與Q3組BGmean差異有顯著統(tǒng)計學意義(P0.05),其余指標差異無顯著統(tǒng)計學意義(P0.05);Q1組與Q3組年齡、BGmean、BGSD、GLI、MAG、呼吸機使用時間差異有顯著統(tǒng)計學意義(P0.05),其余指標差異無顯著統(tǒng)計學意義(P0.05);(5)根據(jù)所有患者BGmean中位數(shù)(9.88mmol/L)及GLI中位數(shù)(13.58(mmol/L)2/h/d),將患者分為四組,低BGmean+高GLI組患者28d病死率較低BGmean+低GLI組患者高,差異有顯著統(tǒng)計學意義(P0.05),高BGmean+高GLI組患者28d病死率較高BGmean+低GLI組患者病死率高,差異有顯著統(tǒng)計學意義(P0.05),而低BGmean+低GLI組患者與高BGmean+高GLI組患者、低BGmean+高GLI組患者與高BGmean+高GLI組患者28d病死率差異無顯著統(tǒng)計學意義(P0.05)。結(jié)論:血糖波動與重癥患者預后相關,GLI在評估重癥患者病情及預測短期預后的價值優(yōu)于其他血糖波動指標;控制重癥患者GLI可改善患者預后,將重癥患者GLI控制在13.58(mmol/L)2/h/d以下可能是一個相對合理的水平;將重癥患者血糖水平控制在7.8~10.0mmol/L可能是一個相對合理的范圍;劇烈的血糖波動性對重癥患者機體的傷害大于高血糖對機體的損害。
[Abstract]:Objective: to analyze the correlation between mean blood glucose and blood glucose in patients with severe volatility and prognosis, while the average blood glucose and blood glucose fluctuation control in a reasonable range, the reasonable control of blood glucose in patients with severe guidance. Methods: This study is an observational study, from January 2016 ~2016 year in December admitted to the Guizhou Medical University ICU the Division also met the inclusion and exclusion criteria of the study patients, according to different statistical analysis as follows: first, according to the prognosis of 28d patients were divided into survival group and death group, the difference between the two groups of patients with clinical data and blood related indicators; second, application of sensibility curve (ROC curve) value evaluation APACHE II score and blood glucose on prognosis of 28d; third, statistical response the glucose fluctuation index blood glucose instability index (GLI), according to GLI's four bit number (1.09,6.66,13.58,26 .49206.00) patients were divided into four groups: group G1: GLI in 0%~25% (1.09 (mmol/L) 2/h/d = GLI = 6.66 (mmol/L) 2/h/d) interval, group G2: GLI in 26%~50% (6.66 (mmol/L) 2/h/dGLI = 13.58 (mmol/L) 2/h/d) interval, group G3: GLI in 51%~75% (13.58 (mmol/L 2/h/) dGLI 26.49 (mmol/L) 2/h/d) interval, group G4: GLI in 76%~100% (26.4 (mmol/L) 2/h/d9GLI = 206 (mmol/L) 2/h/d) were compared between the groups of interval, patients with APACHE II score, mean blood glucose (BGmean), the mortality rate of 28d, differences ICU time and the use of ventilator; fourth the average blood glucose, 7.8mmol/L, 10.0mmol/L, the patients were divided into three groups: group Q1: BGmean10.0mmol/L, group Q2: 7.8mmol/L = BGmean = 10.0mmol/L, BGmean7.8mmol/L, Q3 group were compared between the three groups of patients with the mortality rate of 28d, the differences between general clinical data and blood glucose fluctuation index; fifth, to BGmean (median 9.88mmol/L) is bounded, 灝咮Gmean鍒嗕負楂楤Gmean緇，

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