Pickham David, Flowers Elena, Drew Barbara J
David Pickham, PhD, RN Assistant Adjunct Professor, Department of Physiological Nursing, University of California, San Francisco. Elena Flowers, PhD, RN, MS, MAS Assistant Professor, Department of Physiological Nursing, University of California, San Francisco. Barbara J. Drew, PhD, RN Professor, Department of Physiological Nursing, University of California, San Francisco.
J Cardiovasc Nurs. 2014 May-Jun;29(3):264-70. doi: 10.1097/JCN.0b013e31827f174c.
The QT interval on an electrocardiogram represents ventricular repolarization time. Increased length of this interval, known as corrected QT (QTc) prolongation, can be a precursor to torsade de pointes, a potentially life-threatening ventricular dysrhythmia. An association exists between blood glucose and QTc interval in ambulatory populations. Because both hyperglycemia and QTc prolongation are common in critically ill patients, we sought to examine the relationship between blood glucose, QTc interval prolongation, and all-cause mortality in critically ill patients.
We studied adult patients admitted to cardiac monitoring units. Blood glucose and other clinical variables were abstracted from the medical record. Corrected QT measurements were automatically derived from continuous bedside cardiac monitoring systems.
Twenty-five percent (233/940) of the patients had QTc prolongation, and 53% had elevated blood glucose (>140 mg/dL) during hospitalization. Adjusted odds for QTc prolongation were 2.1 (95% confidence interval, 1.5-3.1) for moderately elevated blood glucose (140-180 mg/dL) and 3.7 (95% confidence interval, 2.5-5.4) for severely elevated blood glucose (>180 mg/dL). Mortality rate was highest (16%) in patients experiencing both severely elevated blood glucose (>180 mg/dL) and QTc interval prolongation.
Hyperglycemia is linked with QTc prolongation, and both are associated with increased odds of mortality in critically ill patients. Further studies are needed to extrapolate the relationship between glucose and ventricular repolarization, as well as appropriate glucose control parameters and QTc interval monitoring in critical care units.
心电图上的QT间期代表心室复极时间。该间期延长，即校正QT（QTc）延长，可能是尖端扭转型室速的先兆，这是一种潜在的危及生命的室性心律失常。动态人群中血糖与QTc间期之间存在关联。由于高血糖和QTc延长在重症患者中都很常见，我们试图研究重症患者的血糖、QTc间期延长与全因死亡率之间的关系。
我们研究了入住心脏监护病房的成年患者。从病历中提取血糖和其他临床变量。QTc测量值自动从床边连续心脏监测系统得出。
25%（233/940）的患者出现QTc延长，53%的患者在住院期间血糖升高（>140mg/dL）。血糖中度升高（140 - 180mg/dL）时，QTc延长的校正比值比为2.1（95%置信区间，1.5 - 3.1）；血糖严重升高（>180mg/dL）时，校正比值比为3.7（95%置信区间，2.5 - 5.4）。血糖严重升高（>180mg/dL）且QTc间期延长的患者死亡率最高（16%）。
高血糖与QTc延长有关，且二者均与重症患者死亡率增加有关。需要进一步研究以推断葡萄糖与心室复极之间的关系，以及重症监护病房中合适的血糖控制参数和QTc间期监测。
