接受肠外营养的外科重症患者出现高血糖与不良预后相关。

Hyperglycemia is associated with poor outcomes in surgical critically ill patients receiving parenteral nutrition.

作者信息

Yan Chiu-Lan, Huang Yaw-Bin, Chen Chih-Yen, Huang Go-Shine, Yeh Ming-Kung, Liaw Wen-Jinn

机构信息

College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Pharmacy Practice, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.

出版信息

Acta Anaesthesiol Taiwan. 2013 Jun;51(2):67-72. doi: 10.1016/j.aat.2013.06.004. Epub 2013 Aug 12.

DOI:10.1016/j.aat.2013.06.004

PMID:23968657

Abstract

BACKGROUND AND AIMS

Hyperglycemia, a major side effect of patients receiving total parenteral nutrition (PN), is associated with higher mortality in critically ill patients. The aim of this study was to determine whether elevated blood glucose levels would be associated with worse outcomes in patients receiving PN.

METHODS

This retrospective study included postoperative patients admitted to our surgical intensive care unit (SICU) from July 2008 to June 2009. Data collected included blood glucose levels, length of stay, and outcome measures. Correlations among daily average, maximum, and minimum blood glucose levels and outcome measures were calculated.

RESULTS

Sixty-nine patients were enrolled and divided into PN (n = 40) and non-PN (n = 29) groups. The initial mean blood glucose levels were 138.4 ± 63.1 mg/dL and 123.2 ± 41.8 mg/dL for the PN and non-PN groups, respectively. The mean blood glucose concentration was significantly increased (ΔBS = 44.8 ± 57.3 mg/dL; p < 0.001) in the PN group compared with the non-PN group (ΔBS = 39.4 ± 67.0 mg/dL; p = 0.004). The blood glucose concentration was significantly increased and consequently, consumption of insulin was increased on the 2(nd) day of ICU admission. The risk of mortality increased by a factor of 1.3 (OR = 1.30, 95% CI = 1.07-1.59, p = 0.010) for each 10 mg/dL increase in blood glucose level, when the daily maximum blood glucose level was >250 mg/dL. There were no cases of mortality in the current study when the blood glucose levels were controlled below 180 mg/dL. The mean blood glucose level in patients receiving PN was higher in those with diabetes than in those without diabetes (215.5 ± 42.8 vs. 165.8 ± 42.0 mg/dL, respectively, p = 0.001).

CONCLUSION

The blood glucose level was associated with patient outcome and should be intensively monitored in critically ill surgical patients. We suggest that blood glucose levels should be controlled below 180 mg/dL in postoperative critically ill patients.

摘要

背景与目的

高血糖是接受全胃肠外营养（PN）患者的主要副作用，与危重症患者较高的死亡率相关。本研究的目的是确定接受PN治疗的患者血糖水平升高是否与更差的预后相关。

方法

这项回顾性研究纳入了2008年7月至2009年6月入住我院外科重症监护病房（SICU）的术后患者。收集的数据包括血糖水平、住院时间和预后指标。计算每日平均、最高和最低血糖水平与预后指标之间的相关性。

结果

69例患者入组，分为PN组（n = 40）和非PN组（n = 29）。PN组和非PN组的初始平均血糖水平分别为138.4±63.1mg/dL和123.2±41.8mg/dL。与非PN组（ΔBS = 39.4±67.0mg/dL；p = 0.004）相比，PN组的平均血糖浓度显著升高（ΔBS = 44.8±57.3mg/dL；p < 0.001）。入住ICU第2天血糖浓度显著升高，胰岛素消耗量随之增加。当每日最高血糖水平>250mg/dL时，血糖水平每升高10mg/dL，死亡风险增加1.3倍（OR = 1.30，95%CI = 1.07 - 1.59，p = 0.010）。在本研究中，当血糖水平控制在180mg/dL以下时，无死亡病例。接受PN治疗的糖尿病患者的平均血糖水平高于非糖尿病患者（分别为215.5±42.8和165.8±42.0mg/dL，p = 0.001）。