本文關(guān)鍵詞：血糖相關(guān)指標(biāo)與重癥患者預(yù)后的相關(guān)性　出處：《貴州醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 血糖 平均血糖 血糖標(biāo)準(zhǔn)差 血糖變異系數(shù) 平均絕對(duì)血糖改變值 血糖不穩(wěn)定指數(shù) 重癥患者 預(yù)后

【摘要】：目的:分析探討重癥患者平均血糖及血糖波動(dòng)性與預(yù)后的相關(guān)性,同時(shí)將平均血糖及血糖波動(dòng)性控制在一個(gè)相對(duì)合理的范圍,以指導(dǎo)重癥患者血糖的合理控制。方法:本研究是一項(xiàng)觀察性研究,選取2016年1月~2016年12月入住貴州醫(yī)科大學(xué)重癥醫(yī)學(xué)科并符合本次研究納入和排除標(biāo)準(zhǔn)的患者,根據(jù)不同的指標(biāo)統(tǒng)計(jì)分析如下:其一,根據(jù)患者28d預(yù)后分成存活組和死亡組,比較兩組患者一般臨床資料及血糖相關(guān)指標(biāo)的差異;其二,應(yīng)用感受性曲線(ROC曲線)評(píng)價(jià)APACHE II評(píng)分與血糖相關(guān)指標(biāo)對(duì)28d預(yù)后的價(jià)值;其三,統(tǒng)計(jì)反應(yīng)血糖波動(dòng)性的指標(biāo)——血糖不穩(wěn)定指數(shù)(GLI),根據(jù)GLI的四分位數(shù)(1.09、6.66、13.58、26.49、206.00)將患者分為四組,即G1組:GLI在0%~25%(1.09(mmol/L)2/h/d≤GLI≤6.66(mmol/L)2/h/d)區(qū)間,G2組:GLI在26%~50%(6.66(mmol/L)2/h/dGLI≤13.58(mmol/L)2/h/d)區(qū)間,G3組:GLI在51%~75%(13.58(mmol/L)2/h/dGLI≤26.49(mmol/L)2/h/d)區(qū)間,G4組:GLI在76%~100%(26.4(mmol/L)2/h/d9GLI≤206.00(mmol/L)2/h/d)區(qū)間,分別比較上述各組之間患者APACHE II評(píng)分、平均血糖(BGmean)、28d病死率、住ICU時(shí)間及呼吸機(jī)使用情況的差異;其四,以平均血糖7.8mmol/L、10.0mmol/L為界,將患者分成三組,即Q1組:BGmean10.0mmol/L,Q2組:7.8mmol/L≤BGmean≤10.0mmol/L,Q3組:BGmean7.8mmol/L,分別比較上述三組間患者28d病死率、一般臨床資料及血糖波動(dòng)指標(biāo)的差異;其五,以BGmean的中位數(shù)(9.88mmol/L)為界,將BGmean分為高BGmean組(BGmean中位數(shù))和低BGmean組(BGmean≤中位數(shù)),同時(shí)以GLI的中位數(shù)(13.58(mmol/L)2/h/d)為界,將GLI分為高GLI組(GLI中位數(shù))和低GLI組(GLI≤中位數(shù)),聯(lián)合上述兩個(gè)指標(biāo),同時(shí)滿足低BGmean、低GLI的病人記為低BGmean+低GLI組,同時(shí)滿足高BGmean、低GLI的病人記為高BGmean+低GLI組,同時(shí)滿足低BGmean、高GLI的病人記為低BGmean+高GLI組,同時(shí)滿足高BGmean、高GLI的病人記為高BGmean+高GLI組,分別比較上述四組患者一般臨床資料及短期病死率的差異。結(jié)果:(1)死亡組患者APACHE II評(píng)分、呼吸機(jī)使用時(shí)間、平均血糖(BGmean)、血糖不穩(wěn)定指數(shù)(GLI)、血糖標(biāo)準(zhǔn)差(BGSD)、血糖變異系數(shù)(BGCV)、平均絕對(duì)血糖改變值(MAG)均較存活組高,差異均具有顯著統(tǒng)計(jì)學(xué)意義(P0.05),兩組患者年齡、ICU停留時(shí)間差異無顯著統(tǒng)計(jì)學(xué)意義(P0.05)。(2)APACHE II評(píng)分、BGmean、BGSD、BGCV、GLI、MAG對(duì)重癥患者28d病死率的判斷價(jià)值,ROC曲線下面積依次為0.627、0.677、0.780、0.758、0.806、0.799;(3)根據(jù)所有患者GLI的四分位數(shù)將患者分為四組,結(jié)果顯示G1組患者BGmean最低,G4組BGmean最高,差異有顯著統(tǒng)計(jì)學(xué)意義(P0.05),四組患者ICU停留時(shí)間差異無顯著統(tǒng)計(jì)學(xué)意義(P0.05),G4組患者呼吸機(jī)使用時(shí)間最長(zhǎng),其余三組差異無顯著統(tǒng)計(jì)學(xué)意義(P0.05)。28d病死率G4組患者最高,G1組與G2組、G2組與G3組28d病死率差異無顯著統(tǒng)計(jì)學(xué)意義(P0.05),G1組與G3組患者28d病死率差異有顯著統(tǒng)計(jì)學(xué)意義(P0.05);(4)根據(jù)平均血糖7.8mmol/L、10.0mmol/L,將患者分為三組,Q1組與Q2組BGmean、BGSD、BGCV、GLI、MAG及呼吸機(jī)使用時(shí)間差異有顯著統(tǒng)計(jì)學(xué)意義(P0.05),其余指標(biāo)差異無顯著統(tǒng)計(jì)學(xué)意義(P0.05);Q2組與Q3組BGmean差異有顯著統(tǒng)計(jì)學(xué)意義(P0.05),其余指標(biāo)差異無顯著統(tǒng)計(jì)學(xué)意義(P0.05);Q1組與Q3組年齡、BGmean、BGSD、GLI、MAG、呼吸機(jī)使用時(shí)間差異有顯著統(tǒng)計(jì)學(xué)意義(P0.05),其余指標(biāo)差異無顯著統(tǒng)計(jì)學(xué)意義(P0.05);(5)根據(jù)所有患者BGmean中位數(shù)(9.88mmol/L)及GLI中位數(shù)(13.58(mmol/L)2/h/d),將患者分為四組,低BGmean+高GLI組患者28d病死率較低BGmean+低GLI組患者高,差異有顯著統(tǒng)計(jì)學(xué)意義(P0.05),高BGmean+高GLI組患者28d病死率較高BGmean+低GLI組患者病死率高,差異有顯著統(tǒng)計(jì)學(xué)意義(P0.05),而低BGmean+低GLI組患者與高BGmean+高GLI組患者、低BGmean+高GLI組患者與高BGmean+高GLI組患者28d病死率差異無顯著統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:血糖波動(dòng)與重癥患者預(yù)后相關(guān),GLI在評(píng)估重癥患者病情及預(yù)測(cè)短期預(yù)后的價(jià)值優(yōu)于其他血糖波動(dòng)指標(biāo);控制重癥患者GLI可改善患者預(yù)后,將重癥患者GLI控制在13.58(mmol/L)2/h/d以下可能是一個(gè)相對(duì)合理的水平;將重癥患者血糖水平控制在7.8~10.0mmol/L可能是一個(gè)相對(duì)合理的范圍;劇烈的血糖波動(dòng)性對(duì)重癥患者機(jī)體的傷害大于高血糖對(duì)機(jī)體的損害。
[Abstract]:Objective: to analyze the correlation between mean blood glucose and blood glucose in patients with severe volatility and prognosis, while the average blood glucose and blood glucose fluctuation control in a reasonable range, the reasonable control of blood glucose in patients with severe guidance. Methods: This study is an observational study, from January 2016 ~2016 year in December admitted to the Guizhou Medical University ICU the Division also met the inclusion and exclusion criteria of the study patients, according to different statistical analysis as follows: first, according to the prognosis of 28d patients were divided into survival group and death group, the difference between the two groups of patients with clinical data and blood related indicators; second, application of sensibility curve (ROC curve) value evaluation APACHE II score and blood glucose on prognosis of 28d; third, statistical response the glucose fluctuation index blood glucose instability index (GLI), according to GLI's four bit number (1.09,6.66,13.58,26 .49206.00) patients were divided into four groups: group G1: GLI in 0%~25% (1.09 (mmol/L) 2/h/d = GLI = 6.66 (mmol/L) 2/h/d) interval, group G2: GLI in 26%~50% (6.66 (mmol/L) 2/h/dGLI = 13.58 (mmol/L) 2/h/d) interval, group G3: GLI in 51%~75% (13.58 (mmol/L 2/h/) dGLI 26.49 (mmol/L) 2/h/d) interval, group G4: GLI in 76%~100% (26.4 (mmol/L) 2/h/d9GLI = 206 (mmol/L) 2/h/d) were compared between the groups of interval, patients with APACHE II score, mean blood glucose (BGmean), the mortality rate of 28d, differences ICU time and the use of ventilator; fourth the average blood glucose, 7.8mmol/L, 10.0mmol/L, the patients were divided into three groups: group Q1: BGmean10.0mmol/L, group Q2: 7.8mmol/L = BGmean = 10.0mmol/L, BGmean7.8mmol/L, Q3 group were compared between the three groups of patients with the mortality rate of 28d, the differences between general clinical data and blood glucose fluctuation index; fifth, to BGmean (median 9.88mmol/L) is bounded, 灝咮Gmean鍒嗕負(fù)楂楤Gmean緇，

本文編號(hào)：1387329