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在血糖控制下,血糖值低于或等于120mg/dL与非糖尿病重症监护病房中患有脓毒症和应激性高血糖的患者14天死亡率增加相关。

A minimum blood glucose value less than or equal to 120 mg/dL under glycemic control is associated with increased 14-day mortality in nondiabetic intensive care unit patients with sepsis and stress hyperglycemia.

作者信息

Chan Ming-Cheng, Tseng Jeng-Sen, Hsu Kuo-Hsuan, Shih Sou-Jen, Yi Chi-Yuan, Wu Chieh-Liang, Kou Yu Ru

机构信息

Institute of Physiology, National Yang-Ming University, Taipei, Taiwan; Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.

Division of Chest Medicine, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.

出版信息

J Crit Care. 2016 Aug;34:69-73. doi: 10.1016/j.jcrc.2016.04.002. Epub 2016 Apr 9.

Abstract

PURPOSE

Hyperglycemia is common in critically ill patients, but results of previous trials on glycemic control have been controversial. This study aimed to investigate whether the minimum blood glucose value during the first 72 hours after admission (72-min-BGV) was associated with mortality in patients with severe sepsis.

MATERIALS AND METHODS

This is a retrospective analysis of prospectively acquired clinical data from an intensive care unit of a tertiary referral hospital in central Taiwan. Patients were included if they were admitted due to severe sepsis from July 2010 to June 2011.

RESULTS

A total of 127 patients (100 males and 27 females) were included for analysis. A 72-min-BGV less than or equal to 120 mg/dL was associated with increased 14-day mortality. Further subgroup analysis revealed that this association existed only in the patients without diabetes. In multivariate logistic regression analysis, a 72-min-BGV less than or equal to 120 mg/dL was an independent risk factor for 14-day mortality (adjusted odds ratio, 5.09; 95% confidence interval, 1.26-23.33; P= .024) in the patients without diabetes.

CONCLUSIONS

A 72-min-BGV less than or equal to 120 mg/dL was an independent risk factor for 14-day mortality in nondiabetic patients with hyperglycemia admitted to our intensive care unit due to severe sepsis, but not in diabetic patients under the same setting.

摘要

目的

高血糖在重症患者中很常见,但以往关于血糖控制的试验结果存在争议。本研究旨在调查入院后72小时内的最低血糖值(72分钟最低血糖值)是否与严重脓毒症患者的死亡率相关。

材料与方法

这是一项对台湾中部一家三级转诊医院重症监护病房前瞻性收集的临床数据进行的回顾性分析。纳入2010年7月至2011年6月因严重脓毒症入院的患者。

结果

共纳入127例患者(男性100例,女性27例)进行分析。72分钟最低血糖值小于或等于120mg/dL与14天死亡率增加相关。进一步的亚组分析显示,这种关联仅存在于无糖尿病的患者中。在多因素逻辑回归分析中,72分钟最低血糖值小于或等于120mg/dL是无糖尿病患者14天死亡率的独立危险因素(调整后的优势比为5.09;95%置信区间为1.26 - 23.33;P = 0.024)。

结论

对于因严重脓毒症入住我们重症监护病房的高血糖非糖尿病患者,72分钟最低血糖值小于或等于120mg/dL是14天死亡率的独立危险因素,但在相同情况下的糖尿病患者中并非如此。

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