血糖变异度与ICU重症结核患者不良预后的相关性

摘要

目的 探讨血糖变异度与ICU重症结核患者不良预后的相关性.方法 选取2016年7月至2017年7月我院ICU收治的重症结核患者96例,按照结局分为存活组65例,死亡组31例.对比分析两组血糖监测指标,并分析不同水平血糖标准差(GluSD)与血糖变异率(GluCV)对患者预后的影响,对具有统计学意义的差异指标进行Logistic回归分析.结果 两组血糖最大值(GluMax)与平均血糖(GluAve)均无明显差异(P>0.05),存活组GluSD与GluCV均明显低于死亡组(P<0.05),低血糖发生率存活组(7.69%)明显低于死亡组(35.48%,P<0.05),应激性高血糖发生率存活组(7.69%)明显低于死亡组(41.94%,P<0.05).按照GluCV与GluSD四分位数将患者分为G1、G2、G3、G4四个组.随着GluCV、GluSD增加,重症结核患者APACHEⅡ评分及死亡率逐渐增加,机械通气时间和ICU重症监护时间逐渐延长(P<0.05),但G4组机械通气时间和ICU重症监护时间相比于 G3组明显降低(P<0.05).Logistic 回归分析发现,APACHEⅡ评分、GluSD、GluCV与发生低血糖与重症结核患者不良预后具有相关性(P<0.05).结论 血糖变异度与ICU重症结核患者不良预后具有相关性,可以准确预测重症结核患者的预后,在临床上可作为判断重症结核患者预后的重要依据,进行推广使用.%Objective To investigate the correlation between blood glucose variability and poor prognosis in ICU patients with severe tuberculosis. Methods From July 2001 to July 2017,96 patients with severe tuberculosis were divided into the survival group(n=65) and the death group(n=31). The effects of GluSD and GluCV on the prognosis of the patients were analyzed. Logistic regression analysis was used to analyze the differences between the two groups. Results There was no significant difference in Glumax and mean blood glucose between the two groups (P>0.05). The levels of GLUSD and GLUCV in the survival group were significantly lower than in the death group (P<0.05),and the incidence of hypoglycemia was significantly lower in the survival group (7.69%) than in the death group (35.48%,P<0.05). The incidence of stress hyperglycemia in the survival group (7.69%) was sig-nificantly lower than that in the death group(41.94%,P<0.05). According to GluCV and GluSD quartile,the pa-tients were divided into G1, G2, G3, G4 four groups. With the increase of GluCV and GluSD, the APACHE Ⅱscore and mortality of patients with severe tuberculosis increased gradually(P<0.05),but in the G4 group,the du-ration of mechanical ventilation and ICU intensive care were significantly lower than those in the G3 group (P <0.05). Logistic regression analysis showed that APACHE Ⅱ score, GluSD and GluCV were correlated with the oc-currence of hypoglycemia and the adverse prognosis of patients with severe tuberculosis (P<0.05). Conclusion The correlation between blood glucose variability and poor prognosis of ICU patients with severe tuberculosis can accu-rately predict the prognosis of patients with severe tuberculosis and can be used as an important basis for judging the prognosis of patients with severe tuberculosis.