老年患者可能从严格的血糖控制中获益。
Elderly patients may benefit from tight glucose control.
机构信息
University of Colorado, Denver, CO, USA.
出版信息
Surgery. 2012 Sep;152(3):315-21. doi: 10.1016/j.surg.2012.06.015.
BACKGROUND
While minimizing hyperglycemia in critically injured patients improves outcomes, it is debatable whether postinjury glucose control should aim for conventional glucose control levels (≤180 mg/dL) or tight glucose control levels (81-108 mg/dL). We queried our 17-year prospective database of patients at risk for postinjury multiple organ failure to examine the association between glucose levels and adverse outcomes.
METHODS
Acutely injured patients admitted to a Level I trauma center intensive care unit from 1992 to 2008 who were more than 15 years of age, had Injury Severity Scores >15, and who survived >48 hours were eligible for the study. Multiple logistic regression was used to determine the independent association of glucose control with adverse outcomes (death, ventilator-free days, intensive care unit-free days, and major infections), adjusted for Injury Severity Score, age, and red blood cell transfusion in the first 12 hours.
RESULTS
Overall, 2,231 patients were eligible, of whom 153 (6.9%) died. The mean age was 37.8 ± 0.4 years, and the median Injury Severity Score was 27 (interquartile range, 21-35). The majority (77%) of these patients maintained mean glucose within conventional glucose control levels and only 10% achieved mean glucose levels within tight glucose control levels. Nonsurvivors required greater doses of insulin to control glucose levels and had greater mean insulin to glucose ratios (t test; P = .025). After adjusting for confounders, mean glucose remained significantly associated with the studied adverse outcomes. Age significantly modified all these associations with older patients seeming to benefit more from tight glucose control levels than their younger counterparts.
CONCLUSION
Age is an effect modifier of the association between glucose levels and adverse outcomes. Future studies including larger samples of elderly trauma patients are needed to determine the ideal levels for glucose control in this growing population.
背景
虽然将危重症患者的血糖水平控制在最低限度可改善预后，但对于伤后血糖控制应达到常规血糖控制水平（≤180mg/dL）还是严格血糖控制水平（81-108mg/dL）仍存在争议。我们查询了我们 17 年的危重伤患者多器官衰竭后前瞻性数据库，以检查血糖水平与不良结局之间的关系。
方法
从 1992 年至 2008 年，在 1 级创伤中心重症监护病房住院的年龄超过 15 岁、损伤严重程度评分（Injury Severity Score，ISS）>15 且生存时间超过 48 小时的急性损伤患者符合研究条件。采用多因素逻辑回归分析来确定血糖控制与不良结局（死亡、无呼吸机天数、无重症监护室天数和重大感染）之间的独立相关性，校正 ISS、年龄和伤后 12 小时内的红细胞输注。
结果
共有 2231 例患者符合条件，其中 153 例（6.9%）死亡。患者的平均年龄为 37.8±0.4 岁，ISS 中位数为 27（四分位距，21-35）。这些患者中大多数（77%）的平均血糖控制在常规血糖控制水平内，只有 10%的患者达到了严格血糖控制水平的平均血糖水平。未存活者需要更大剂量的胰岛素来控制血糖水平，且平均胰岛素与血糖比值更高（t 检验；P=0.025）。在调整混杂因素后，平均血糖水平仍与所研究的不良结局显著相关。年龄显著改变了所有这些关联，年龄较大的患者似乎从严格血糖控制水平中获益更多，而年龄较小的患者则不然。
结论
年龄是血糖水平与不良结局之间关联的一个效应修饰因素。需要进一步开展包括更多老年创伤患者的大型样本研究，以确定这一不断增长的人群中血糖控制的理想水平。
Zotero 插件