Silveira L M, Basile-Filho A, Nicolini E A, Dessotte C A M, Aguiar G C S, Stabile A M
Fundamental Nursing Program, College of Nursing, University of São Paulo at Ribeirão Preto, Ribeirão Preto, São Paulo, Brazil.
Department of Surgery and Anatomy, Ribeirão Preto Medical School of the University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
Intensive Crit Care Nurs. 2017 Aug;41:98-103. doi: 10.1016/j.iccn.2017.01.004. Epub 2017 Mar 18.
Sepsis is associated with morbidity and mortality, which implies high costs to the global health system. Metabolic alterations that increase glycaemia and glycaemic variability occur during sepsis.
To verify mean body glucose levels and glycaemic variability in Intensive Care Unit (ICU) patients with severe sepsis or septic shock.
Retrospective and exploratory study that involved collection of patients' sociodemographic and clinical data and calculation of severity scores. Glycaemia measurements helped to determine glycaemic variability through standard deviation and mean amplitude of glycaemic excursions.
Analysis of 116 medical charts and 6730 glycaemia measurements revealed that the majority of patients were male and aged over 60 years. Surgical treatment was the main reason for ICU admission. High blood pressure and diabetes mellitus were the most usual comorbidities. Patients that died during the ICU stay presented the highest SOFA scores and mean glycaemia; they also experienced more hypoglycaemia events. Patients with diabetes had higher mean glycaemia, evaluated through standard deviation and mean amplitude of glycaemia excursions.
Organic impairment at ICU admission may underlie glycaemic variability and lead to a less favourable outcome. High glycaemic variability in patients with diabetes indicates that monitoring of these individuals is crucial to ensure better outcomes.
脓毒症与发病率和死亡率相关，这意味着全球卫生系统将承担高昂成本。脓毒症期间会出现导致血糖升高和血糖变异性增加的代谢改变。
验证重症监护病房（ICU）中患有严重脓毒症或脓毒性休克患者的平均血糖水平和血糖变异性。
一项回顾性探索性研究，涉及收集患者的社会人口统计学和临床数据以及计算严重程度评分。血糖测量有助于通过标准差和血糖波动平均幅度来确定血糖变异性。
对116份病历和6730次血糖测量结果的分析显示，大多数患者为男性，年龄超过60岁。手术治疗是入住ICU的主要原因。高血压和糖尿病是最常见的合并症。在ICU住院期间死亡的患者SOFA评分和平均血糖最高；他们还经历了更多的低血糖事件。通过血糖波动标准差和平均幅度评估，糖尿病患者的平均血糖更高。
入住ICU时的器官损害可能是血糖变异性的基础，并导致预后较差。糖尿病患者的高血糖变异性表明，对这些患者进行监测对于确保更好的预后至关重要。
