入院时高血糖或低白蛋白血症对重症创伤患者使用呼吸机的需求、通气时间、死亡率和发病率的影响。

The impact of admission hyperglycemia or hypoalbuminemia on need ventilator, time ventilated, mortality, and morbidity in critically ill trauma patients.

作者信息

Safavi Mohammadreza, Honarmand Azim

机构信息

Department of Anesthesiology and Intensive Care, Isfahan University of Medical Sciences, Isfahan, Iran.

出版信息

Ulus Travma Acil Cerrahi Derg. 2009 Mar;15(2):120-9.

PMID:19353313

Abstract

BACKGROUND

The aim of this study was to evaluate the value of hypoalbuminemia or hyperglycemia as predictors for need ventilator and for weaning success in critically ill trauma patients.

METHODS

A single center, retrospective trial was done on 600 trauma patients = or >16 years old admitted for three or more days to the intensive care unit. Patients were classified into five different groups according to the reason for respiratory failure. The subsequent parameters were noted: serum albumin and glucose concentration, Acute Physiology and Chronic Health Evaluation III score, need ventilator, ventilator days, and fluid balance.

RESULTS

The initial mean serum glucose concentration was 9.3 (167.4) +/- 0.2 (3.6 mg/dl) mmol/L and the initial mean serum albumin concentration was 30.2 (3.02) +/- 0.02 (0.2 g/dl) g/L. Even though the circulating albumin concentration was considerably lower and serum glucose concentration was significantly higher in ICU nonsurvivors than in ICU survivors, neither albumin (r=-0.031, p=0.23) nor blood glucose concentration (r=0.050, p=0.11) on ICU admission was a predictor of the duration of mechanical ventilation. The profile of albumin and glucose concentration changes was dissimilar between weaned and mechanical ventilation-dependent patients. An increase of 5 g/L (0.5 g/dl) in serum albumin concentration multiplied the relative success probability by 1.10. Patients with serum albumin concentration less than 30.3 (3.03 g/dl) g/L were 1.2 times more likely to need ventilator than normo-albuminemic patients (relative risk 1.2, 95% confidence interval 1.06-1.31). The risk of need mechanical ventilation did not increase with blood glucose concentration more than 11 mmol/L (200 mg/dl).

CONCLUSION

These results suggest that albumin and blood glucose are possible indexes of the metabolic status of the trauma patient, which could be essential in deciding the need ventilator and weanable status of the patients who are mechanically ventilated for extended periods of time.

摘要

背景

本研究旨在评估低白蛋白血症或高血糖作为预测重症创伤患者是否需要机械通气及撤机成功的价值。

方法

对入住重症监护病房3天及以上、年龄≥16岁的600例创伤患者进行了一项单中心回顾性试验。根据呼吸衰竭原因将患者分为五个不同组。记录以下参数：血清白蛋白和葡萄糖浓度、急性生理与慢性健康状况评分Ⅲ、是否需要机械通气、机械通气天数及液体平衡情况。

结果

初始平均血清葡萄糖浓度为9.3（167.4）±0.2（3.6mg/dl）mmol/L，初始平均血清白蛋白浓度为30.2（3.02）±0.02（0.2g/dl）g/L。尽管重症监护病房非存活者的循环白蛋白浓度明显较低，血清葡萄糖浓度明显较高，但入住重症监护病房时白蛋白（r=-0.031，p=0.23）和血糖浓度（r=0.050，p=0.11）均不是机械通气时间的预测指标。撤机患者和依赖机械通气患者的白蛋白和葡萄糖浓度变化情况不同。血清白蛋白浓度每增加5g/L（0.5g/dl），相对成功概率乘以1.10。血清白蛋白浓度低于30.3（3.03g/dl）g/L的患者需要机械通气的可能性是白蛋白正常患者的1.2倍（相对风险1.2，95%置信区间1.06-1.31）。血糖浓度超过11mmol/L（200mg/dl）时，需要机械通气的风险并未增加。