發(fā)布時間：2019-01-16 01:06

【摘要】：目的:通過觀察、對比不同血糖控制目標(biāo)危重患者的短期并發(fā)癥及預(yù)后,研究不同血糖控制目標(biāo)對危重患者的影響。提高重癥醫(yī)學(xué)科(intensive care unit,ICU)醫(yī)護人員對危重患者血糖的重視程度,強調(diào)血糖監(jiān)測的重要性,為臨床治療提供依據(jù)。方法:1研究對象及分組保定市第二中心醫(yī)院ICU2013年9月-2015年2月期間就診的患者。入選標(biāo)準(zhǔn):①入住ICU≥5d;②急性生理和慢性健康狀況評價系統(tǒng)II(acute physiology and chronic health evaluation II,APACHE-II)評分≥8分;③隨機血糖≥11.1mmol/L的患者。排除標(biāo)準(zhǔn):有糖尿病史、長期服用糖皮質(zhì)激素病史的患者。根據(jù)排除標(biāo)準(zhǔn)及符合入選標(biāo)準(zhǔn)的②③,共計納入患者230例,采用前瞻性研究將患者隨機分為兩組,最終符合上述①②③入選標(biāo)準(zhǔn)的患者152例,A組76例,B組76例。采用快速血糖儀(羅氏羅康全活力型血糖儀)監(jiān)測血糖。血糖儀與檢驗科生化方法檢測結(jié)果定期進(jìn)行比對,確�？焖傺潜O(jiān)測的準(zhǔn)確性。入選的兩組患者分別給予0.9%氯化鈉50ml+普通胰島素50u微量注射泵靜脈泵入控制血糖,在24~72小時內(nèi)將血糖控制在兩個不同的目標(biāo)范圍內(nèi),其中A組血糖控制目標(biāo)為:6.0~7.7mmol/L,B組血糖控制目標(biāo)為:7.8~10.0mmol/L。治療過程中監(jiān)測Q1~4小時的快速血糖值,并根據(jù)血糖變化情況,按照血糖控制方案調(diào)整監(jiān)測血糖頻率及普通胰島素泵入速度,維持兩組血糖監(jiān)測目標(biāo)。2監(jiān)測參數(shù)統(tǒng)計患者年齡、APACHE-Ⅱ評分、入住ICU時間、發(fā)生感染并發(fā)癥例數(shù)(肺部感染、導(dǎo)管相關(guān)的血流感染、導(dǎo)尿管相關(guān)的尿路感染)、發(fā)生低血糖并發(fā)癥例數(shù)、ICU死亡例數(shù)。所有結(jié)果采用SPSS17.0軟件建立數(shù)據(jù)庫并進(jìn)行統(tǒng)計分析,計量資料以均數(shù)±標(biāo)準(zhǔn)差(x±s)表示,兩組對比采用t檢查;計數(shù)資料用χ2檢驗,P0.05有統(tǒng)計學(xué)意義,表示二者差異顯著。結(jié)果:1兩組一般情況:A組76例,其中男性40例,女性36例,平均年齡71.43±12.80歲(21~93歲),入院24小時平均APACHE-Ⅱ評分16.95±7.94分(8~40分)。B組76例,其中男性43例,女性33例,平均年齡67.93±13.38歲(11~93歲),入院24小時平均APACHE-Ⅱ評分16.93±7.87分(8~51分)。兩組患者的性別、年齡、危重程度均無統(tǒng)計學(xué)差異(P0.05,見Table 1)。2兩組并發(fā)癥:A組發(fā)生感染并發(fā)癥10例,B組發(fā)生感染并發(fā)癥13例,兩組患者感染并發(fā)癥的發(fā)生率無統(tǒng)計學(xué)差異(P0.05,見Table 2)。A組中肺部感染(hospital acqurired pneumonia,HAP)9例,其中呼吸機相關(guān)性肺炎(ventilator associated pneumonia,VAP)1例,導(dǎo)尿管相關(guān)的尿路感染(catheter associated urinary tract infection,CAUTI)1例;B組中肺部感染(hospital acqurired pneumonia,HAP)11例,導(dǎo)管相關(guān)的血流感染(catheter-related bloodstream infection,CRBSI)1例,導(dǎo)尿管相關(guān)的尿路感染(catheter associated urinary tract infection,CAUTI)1例(見Table 2.2)。A組發(fā)生低血糖并發(fā)癥8例,B組發(fā)生低血糖并發(fā)癥2例,兩組患者低血糖并發(fā)癥的發(fā)生率有統(tǒng)計學(xué)差異,A組低血糖并發(fā)癥發(fā)生率10.52%,B組低血糖并發(fā)癥發(fā)生率2.63%,A組的低血糖并發(fā)癥發(fā)生率明顯高于B組(P0.05,見Table 3)。3兩組預(yù)后:A組患者ICU平均住院時間11.37±8.31天,B組患者ICU平均住院時間11.88±7.97天,兩組患者ICU住院時間無統(tǒng)計學(xué)差異(P0.05,見Table 4)。A組ICU實際死亡20例,B組ICU實際死亡17例,兩組患者ICU死亡率無統(tǒng)計學(xué)差異(P0.05,見Table 4)。結(jié)論:1危重患者血糖目標(biāo)控制在7.8~10.0mmol/L,和6.0~7.7mmol/L相比較,可以改善患者低血糖并發(fā)癥,但不改善感染的并發(fā)癥。2危重患者血糖目標(biāo)控制在7.8~10.0mmol/L,和6.0~7.7mmol/L相比較,不能縮短ICU住院時間和改善ICU生存率。
[Abstract]:Objective: To study the effect of different blood glucose control objectives on critical patients by observing the short-term complications and prognosis of critical patients with different blood glucose control objectives. To improve the importance of the medical staff of intensive care unit (ICU) to the blood sugar of critically ill patients, and to emphasize the importance of blood glucose monitoring and provide the basis for clinical treatment. Methods: 1 subject and the second central hospital, ICU13, September-February, 2015. Inclusion criteria: admitted to ICU for 5days; acute physiology and chronic health evaluation system II (APACHE-II) scored a score of 8; and a patient with a random blood glucose of 11. 1mmol/ L. Exclusion criteria: a history of diabetes and a long-term patient with a history of corticosteroids. According to the exclusion criteria and the criteria for inclusion, a total of 230 patients were included in the study, and the patients were randomly divided into two groups using a prospective study, in which 152 patients, 76 in group A and 76 in group B, were randomly divided into two groups. The blood glucose was monitored with a rapid meter (Roche's full-energy meter). The blood glucose meter is compared with the test result of the biochemical method of the laboratory to ensure the accuracy of the rapid blood glucose monitoring. The control of blood glucose was controlled within 24-72 hours. The control target of blood sugar in group A was: 6. 0-7. 7mmol/ L, and the control target of blood sugar in group B was 7. 8-10. 0mmol/ L. monitoring the rapid blood sugar level of Q1 to 4 hours in the treatment process, adjusting the monitoring blood glucose frequency and the normal insulin pump input speed according to the blood sugar control scheme according to the blood sugar change condition, maintaining the two groups of blood glucose monitoring targets, Number of complications of infection (pulmonary infection, catheter-related blood flow infection, urinary catheter-related urinary tract infection), number of complications with hypoglycaemia, number of ICU deaths. All the results were based on the SPSS17.0 software, and the statistical analysis was carried out. The mean standard deviation (x% s) was used for the measurement data, and t-test was used for the two groups. The count data was used for the second test, and the difference between the two groups was statistically significant, indicating that the difference was significant. Results: A group of 76 cases were divided into two groups, including 40 male and 36 female, with average age of 71. 43 and 12. 80 years (21 to 93 years). The average APACHE-鈪，

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