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目的探讨危重症患者血糖动态水平监测及其对患者预后的影响。方法收集綦江县人民医院急诊ICU收治的危重症患者160例,以入院时空腹血糖升高的程度进行分组:A组(血糖≤6.1 mmol/L)21例,B组(血糖6.1~10mmol/L)68例,C组(血糖≥10 mmol/L)71例。应用美国强生one TouchR ultraTM微机血糖仪及试纸对所有患者进行血糖动态监测。观察三组患者入ICU时急性生理和慢性健康状况评分(APACHE Ⅲ评分)、住ICU天数、多器官功能衰竭综合征(MODS)发生率及住院死亡情况。同时根据患者预后,将160例病例分为生存组112例和死亡组48例,收集所有患者入ICU 1、6、12、24、48、72 h时的血糖动态监测结果。结果三组APACHE Ⅲ评分、住ICU天数比较差异均有统计学意义(P均<0.01)。A组和B组MODS发生率均明显低于C组(P均<0.01),而A组MODS发生率略高于B组,但两组之间差异无统计学意义。A组和C组住院死亡率均明显高于B组(P均<0.01),而C组住院死亡率略高于A组,但两组之间差异无统计学意义。在入ICU 1、6、12、24、48、72 h每个时间点上,生存组的血糖水平呈持续下降,而死亡组血糖呈持续升高,明显高于生存组(P均<0.01)。结论血糖动态变化与危重症患者的预后密切相关,可作为危重症患者的重要临床监测指标。
Objective To investigate the monitoring of blood glucose level in critically ill patients and its effect on the prognosis of patients. Methods Totally 160 critically ill patients admitted to emergency ICU of Qijiang County People’s Hospital were divided into two groups: group A (blood glucose ≤ 6.1 mmol / L), group B (blood glucose 6.1-10 mmol / L ) In 68 cases, group C (blood glucose ≥10 mmol / L) in 71 cases. The application of Johnson & Johnson one TouchR ultraTM computer glucose meter and test strips for all patients with blood glucose monitoring. The acute physiology and chronic health status score (APACHE Ⅲ), the number of ICU days, the incidence of multiple organ dysfunction syndrome (MODS) and hospitalized death were observed in the three groups. At the same time, according to the prognosis of patients, 160 cases were divided into 112 survivors and 48 deaths. All the patients were collected at 1, 6, 12, 24, 48 and 72 h of ICU to monitor the blood glucose. Results There were significant differences in APACHE Ⅲ scores and ICU days between the three groups (all P <0.01). The incidence of MODS in group A and group B was significantly lower than that in group C (all P <0.01), while the incidence of MODS in group A was slightly higher than that in group B, but there was no significant difference between the two groups. In-hospital mortality was significantly higher in groups A and C than in group B (P <0.01), while in-hospital mortality in group C was slightly higher than that in group A, but there was no significant difference between the two groups. At each time point of 1, 6, 12, 24, 48, and 72 h after ICU admission, the blood glucose level in survival group continued to decline, while the blood glucose level in death group continued to increase, significantly higher than that in survival group (all P <0.01) . Conclusion The dynamic changes of blood glucose are closely related to the prognosis of critically ill patients and can be used as an important clinical monitoring index for critically ill patients.