Department of Intensive Care Medicine, Frankston Hospital, Frankston, VIC 3199, Australia.
J Crit Care. 2012 Apr;27(2):153-8. doi: 10.1016/j.jcrc.2011.06.011. Epub 2011 Aug 19.
Stress hyperglycemia (SH) is commonly seen in critically ill patients. It has been shown to be associated with adverse outcomes in some groups of patients. The effects of SH on critically ill patients with sepsis have not been well studied. We aimed to evaluate the effects of SH in critically ill patients with sepsis.
In this retrospective study, patients with sepsis admitted to intensive care unit (ICU) over a 5-year period were included.
Of 297 patients, 204 (68.7%) had SH during the study period. The mean blood glucose level in patients with SH was 8.7 mmol/L compared with 5.9 mmol/L in those without SH (P < .05). There were no statistically significant differences in age; sex; sepsis severity; cardiovascular, respiratory, and renal comorbidities; requirement of mechanical ventilation; inotropes; and Acute Physiology, Age, and Chronic Health Evaluation III and Simplified Acute Physiology 2 scores on ICU admission. Intensive care unit mortality was significantly lower in patients who had SH. The median duration of ICU and hospital length of stay was longer in patients with SH. On logistic regression analysis, the presence of SH was associated with reduced ICU mortality. Subgroup analysis revealed SH to be protective in patients with septic shock.
Stress hyperglycemia may not be harmful in critically ill patients with sepsis. Patients with SH had lower ICU mortality.
应激性高血糖（SH）在危重症患者中很常见。一些研究表明，SH 与某些患者的不良预后相关。SH 对脓毒症危重症患者的影响尚未得到很好的研究。我们旨在评估 SH 对脓毒症危重症患者的影响。
在这项回顾性研究中，纳入了在 ICU 住院的脓毒症患者。
在 297 例患者中，204 例（68.7%）在研究期间发生了 SH。SH 患者的平均血糖水平为 8.7mmol/L，而无 SH 的患者为 5.9mmol/L（P<0.05）。在年龄、性别、脓毒症严重程度、心血管、呼吸和肾脏合并症、机械通气需求、正性肌力药、入 ICU 时的急性生理学、年龄和慢性健康评估 III 评分和简化急性生理学评分 2 等方面，两组之间没有统计学差异。发生 SH 的患者 ICU 死亡率显著降低。SH 患者的 ICU 及住院时间中位数更长。在 logistic 回归分析中，SH 的存在与 ICU 死亡率降低相关。亚组分析显示，SH 对脓毒性休克患者有保护作用。
应激性高血糖在脓毒症危重症患者中可能没有危害。发生 SH 的患者 ICU 死亡率较低。
