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摘要: 目的:探讨血糖变化对ICU脓毒症患者预后的影响。方法:回顾性分析2017年1月-2019年12月期间收治的脓毒症患者480例。收集患者的APACHEⅡ,SOFA,SIRS,GCS评分及临床实验室检查指标。根据离开ICU时的预后分为存活组及死亡组。采用受试者工作特征曲线分析各指标在预测脓毒症死亡的敏感度、特异度以及最大约登指数下的界值。对不同血糖波动的患者进行生存分析。结果:存活组和死亡组的临床指标[APACHEⅡ、SOFA、SIRS、GCS、PCT、IL-6、BNP、CRP、PLT、ALB、BUN、CREA、P、PT、APTT、INR、DD、FDP、心率、呼吸、收缩压、Δ血糖(最高血糖与最低血糖差值)、pH、PaO2/FiO2(校正后)、Lac]进行比较,差异有统计学意义(P<0.05)。运用受试者工作特征曲线对脓毒症死亡的预测价值进行分析发现APACHEⅡ,SOFA,Lac及Δ血糖四个指标的曲线下面积接近或超过0.7。以Δ血糖的3.275 mmol/L对患者分组,两组生存率不同(P<0.001)。结论:血糖波动大于3.275 mmol/L时的患者的病死率明显升高;疾病严重程度越高,血糖波动越大。Abstract: Objective: To observe the effect of blood glucose changes on the prognosis of patients with sepsis in ICU.Methods: Clinical data of 480 patients with sepsis were retrospectively analyzed from January 2017 to December 2019. The APACHE Ⅱ, SOFA, SIRS, GCS scores, and the data of clinical laboratory examination from the patients were collected.Patients were divided into survival group and death group when leaving ICU. The ROC curve was used to analyze the sensitivity, specificity and Youden index of each indicator in predicting sepsis death. Survival analysis was performed in patients with different blood glucose fluctuations.Results: The APACHEⅡ, SOFA, SIRS, GCS, PCT, IL-6, BNP, CRP, PLT, ALB, BUN, CREA, P, PT, APTT, INR, DD, FDP, heart rate, respiration, systolic blood pressure, Δblood glucose(difference between the highest and lowest blood glucose), pH, PaO2/FiO2(adjusted), and Lac were significantly different between the two groups(P<0.05). It was found that the area under the curve of APACHE Ⅱ, SOFA, Lac, and Δblood glucose in the predictive value of the receiver operating characteristic curve for sepsis death were close to or more than 0.7. The patients grouped with 3.275 mmol/L of Δblood glucose, and the survival rate was a significant difference between the two groups(P<0.001).Conclusion: The mortality of patients with Δblood glucose greater than 3.275 mmol/L significantly increased. The higher the severity of severe the disease, the greater the fluctuation in blood glucose.
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Key words:
- sepsis /
- blood glucose /
- critical illness /
- prognosis
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