论文部分内容阅读
目的观察糖尿病合并脓毒症休克患者脉搏指示连续心输出量(PiCCO)监测指标的变化,并分析其临床意义。方法选取糖尿病合并脓毒症休克患者(DM+SS组)42例和单纯脓毒症休克患者(SS组)37例,入院24h内均接受PiCCO监测。收集两组入院时的临床资料和生化指标,比较PiCCO监测相关指标的水平。采用Logistic回归分析糖尿病合并脓毒症休克的危险因素。结果入院时,DM+SS组血糖[(15.62±4.71)vs(5.47±0.27)mmol/L]、HbA1c[(7.91±2.22)%vs(5.52±0.74)%]、TG[2.00(1.37,5.44)vs 1.69(0.92,4.17)mmol/L]、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)[(28.31±5.62)vs(22.80±3.74)分]及既往病史中合并脑梗死患者比例[5(11.90%)vs 1(2.70%)]均高于SS组(P<0.05或P<0.01);DM+SS组平均动脉压(MAP)[(53.31±9.82)vs(58.44±9.50)mmHg]、中心静脉压(CVP)[(7.07±1.18)vs(8.24±2.31)mmHg]及心脏指数(CI)[(2.68±0.31)vs(3.47±0.66)L/(min·m~2)]低于SS组,胸腔内血容积指数(ITBVI)[(970.65±153.22)vs(961.44±151.58)ml/m~2]、血管外肺水指数(EVLWI)[(15.27±4.62)vs(11.11±2.16)ml/kg]、体循环阻力指数(SVRI)[(2277.76±457.18)vs(2154.48±433.27)d/(s·m2·cm5)]及肺毛细血管通透性指数(PVPI)[(3.24±1.91)vs(2.01±0.67)]高于SS组(P<0.05或P<0.01);Logistic回归分析发现,年龄、HbA1c、糖尿病合并血管并发症及继发感染是糖尿病合并脓毒症休克的危险因素(P<0.05或P<0.01)。结论糖尿病合并脓毒症休克患者较单纯脓毒症休克患者存在更为严重的血流动力学障碍。高龄、高HbA1c、糖尿病合并血管并发症及继发感染可能是糖尿病合并脓毒症休克的危险因素。
Objective To observe the changes of pulse-controlled continuous cardiac output (PiCCO) in patients with diabetes mellitus and septic shock and to analyze its clinical significance. Methods Forty-two patients with diabetes mellitus and septic shock (DM + SS group) and 37 patients with simple septic shock (SS group) were enrolled in this study. PiCCO monitoring was performed within 24 hours after admission. The clinical data and biochemical indexes of both groups were collected, and the relative indexes of PiCCO monitoring were compared. Logistic regression analysis was used to analyze the risk factors of sepsis in diabetic patients. Results Compared with the control group, the levels of serum glucose ([(15.62 ± 4.71) vs (5.47 ± 0.27) mmol / L], HbA1c [(7.91 ± 2.22)% vs (5.52 ± 0.74)%], TG [2.00 ) vs 1.69 (0.92, 4.17) mmol / L], APACHEⅡ [(28.31 ± 5.62) vs (22.80 ± 3.74) vs the ratio of patients with previous cerebral infarction [5 (53.91 ± 9.82) vs (58.44 ± 9.50) mmHg] in DM + SS group was significantly higher than that in SS group (11.90% vs 1 (2.70%, P <0.05 or P < CVP was significantly lower than CVP [(7.07 ± 1.18) vs (8.24 ± 2.31) mmHg and CI [2.68 ± 0.31 vs (3.47 ± 0.66) L / (min · m 2] SS, intrathoracic blood volume index (ITBVI) [(970.65 ± 153.22) vs (961.44 ± 151.58) ml / m 2], extravascular lung water index (EVLWI) [(15.27 ± 4.62) vs (11.11 ± 2.16) (SVR) [(2277.76 ± 457.18) vs (2154.48 ± 433.27) d / (s · cm · cm5)] and pulmonary capillary permeability index (PVPI) [(3.24 ± 1.91) (2.01 ± 0.67) was higher than that of SS group (P <0.05 or P <0.01). Logistic regression analysis showed that age, HbA1c, diabetes complicated with vascular complications and secondary infection were risk factors of diabetes mellitus with septic shock P <0.05 or P <0.01)Conclusion Patients with diabetes mellitus and septic shock have more severe hemodynamic disorders than those with sepsis alone. Older age, high HbA1c, diabetic complications and secondary infection may be the risk factors of diabetes complicated with septic shock.