Cely Cynthia M, Arora Pratheep, Quartin Andrew A, Kett Daniel H, Schein Roland M H
Section of Critical Care Medicine (111), Miami VAMC, 1201 NW Sixteenth St, Miami, FL 33125, USA.
Chest. 2004 Sep;126(3):879-87. doi: 10.1378/chest.126.3.879.
To elucidate the relationship of baseline glucose control and acute stimuli with hyperglycemia during medical critical illness.
Prospective cohort study.
Medical ICU (MICU) of a university affiliated hospital.
Convenience sample of 100 medical patients meeting criteria for severity of illness and anticipated length of stay and not admitted to the hospital for diabetic ketoacidosis or a hyperglycemic hyperosmolar state.
None.
Patients were categorized as having normal, abnormal, or unevaluable baseline glucose control based on history and glycosylated hemoglobin (HbA1c). Data collection included blood glucose measurements within 120 h of MICU admission, and dosing of norepinephrine, corticosteroids, propofol, and carbohydrates. Average blood glucose and times over glycemic thresholds were calculated using linear interpolation. Hyperglycemia (glucose > 110 mg/dL) was pervasive in all groups. Among the 51 patients with normal baseline glucose control, HbA1c was correlated with hyperglycemic time (p < 0.01, R(2) = 0.15). Multiple regression found HbA1c, age, corticosteroid dose, and carbohydrate administration independently associated with hyperglycemic time (p < 0.05 for each, total R(2) = 0.49) in these patients, while body mass index, APACHE (acute physiology and chronic health evaluation) II, norepinephrine dose, propofol dose, gender, and sepsis were not associated with time > 110 mg/dL. Among normal subjects, HbA1c was independently predictive of peak and average glucose, and the fraction of time glucose was > 150 mg/dL and > 200 mg/dL (p < 0.05 for each). Patients with abnormal baseline glucose control had significantly more hyperglycemia than patients with normal baseline control.
Even in patients without evidence of abnormal glucose homeostasis at baseline, hyperglycemia is common during critical illness. Time exposure to hyperglycemia is correlated with acute stressors and baseline glucose regulation, as characterized by HbA1c. Patients with low HbA1c levels are less disposed to hyperglycemia during severe illness than patients with higher, but still normal, HbA1c.
阐明医学危重症期间基线血糖控制和急性刺激与高血糖之间的关系。
前瞻性队列研究。
一所大学附属医院的内科重症监护病房（MICU）。
选取100例符合疾病严重程度和预期住院时间标准、且非因糖尿病酮症酸中毒或高血糖高渗状态入院的内科患者作为便利样本。
无。
根据病史和糖化血红蛋白（HbA1c）将患者分为基线血糖控制正常、异常或不可评估三类。数据收集包括MICU入院后120小时内的血糖测量，以及去甲肾上腺素、皮质类固醇、丙泊酚和碳水化合物的给药剂量。使用线性插值法计算平均血糖和血糖超过阈值的时间。高血糖（血糖>110mg/dL）在所有组中均普遍存在。在51例基线血糖控制正常的患者中，HbA1c与高血糖时间相关（p<0.01，R² = 0.15）。多元回归分析发现，在这些患者中，HbA1c、年龄、皮质类固醇剂量和碳水化合物摄入量与高血糖时间独立相关（每项p<0.05，总R² = 0.49），而体重指数、急性生理与慢性健康状况评估（APACHE）II评分、去甲肾上腺素剂量、丙泊酚剂量、性别和脓毒症与血糖>110mg/dL的时间无关。在正常受试者中，HbA1c可独立预测血糖峰值和平均值，以及血糖>150mg/dL和>200mg/dL的时间比例（每项p<0.05）。基线血糖控制异常的患者比基线血糖控制正常的患者高血糖情况更显著。
即使在基线时无葡萄糖稳态异常证据的患者中，高血糖在危重症期间也很常见。高血糖的暴露时间与急性应激源和以HbA1c为特征的基线血糖调节相关。HbA1c水平低的患者在重症期间比HbA1c水平较高但仍正常的患者发生高血糖的倾向更低。
