The impact of the severity of sepsis on the risk of hypoglycaemia and glycaemic variability.
The impact of the severity of sepsis on the risk of hypoglycaemia and glycaemic variability.
复制标题
DOI：
10.1186/cc7097
复制
发表时间：
2008
期刊：
影响因子：
--
通讯作者：
Quintel M
中科院分区：
文献类型：
--
作者：
Waeschle RM;Moerer O;Hilgers R;Herrmann P;Neumann P;Quintel M
这项研究的目的是评估一组接受强化胰岛素治疗(IIT)的患者的血糖控制与脓毒症严重程度之间的关系。在一项前瞻性的观察性研究中，重症监护病房(ICU)(n=191)中所有有败血症、严重败血症或感染性休克的患者都接受了IIT治疗(目标血糖(BG)水平为80至140 mg/dl，而不是严格的正常血糖)。通过计算平均值、不同范围内的BG值比率、不同水平内的BG值患者比率以及作为血糖变异性指标的BG值的标准差(SD)来分析BG值。低血糖和高血糖患者的数量与脓毒症的严重程度密切相关(严重低血糖≤40 mg/dl：败血症：2.1%，严重败血症：6.0%，败血症：11.5%，败血症：11.5%，p=0.1497；高血糖：>140 mg/dl：败血症：76.6%，严重败血症：88.0%，败血症：100%，败血症：100%，p=0.0006；>；179 mg/dl：败血症：55.3%，严重败血症：73.5%，败血症：88.5%，p=0.0005；脓毒症：17.0%，严重败血症：48.2%，感染性休克：45.9%，P=0.0011)。多变量分析显示SD水平与危重低血糖显著相关，尤其是感染性休克患者(p=0.0197)。此外，与SD水平低于20 mg/dl的患者相比，SD水平高于20 mg/dl的患者死亡率显著更高(24%对2.5%，p=0.0195)。接受IIT治疗的严重败血症和感染性休克患者发生低血糖和高血糖的风险较高。在这些目标血糖水平较高的患者中，IIT要求提高对临界低血糖发生的认识，这与败血症发作的严重程度有关。
The purpose of this study was to assess the relation between glycaemic control and the severity of sepsis in a cohort of patients treated with intensive insulin therapy (IIT). In a prospective, observational study, all patients in the intensive care unit (ICU) (n = 191) with sepsis, severe sepsis or septic shock were treated with IIT (target blood glucose (BG) level 80 to 140 mg/dl instead of strict normoglycaemia). BG values were analysed by calculating mean values, rate of BG values within different ranges, rate of patients experiencing BG values within different levels and standard deviation (SD) of BG values as an index of glycaemic variability. The number of patients with hypoglycaemia and hyperglycaemia was highly dependent on the severity of sepsis (critical hypoglycaemia ≤ 40 mg/dl: sepsis: 2.1%, severe sepsis: 6.0%, septic shock: 11.5%, p = 0.1497; hyperglycaemia: >140 mg/dl: sepsis: 76.6%, severe sepsis: 88.0%, septic shock: 100%, p = 0.0006; >179 mg/dl: sepsis: 55.3%, severe sepsis: 73.5%, septic shock: 88.5%, p = 0.0005; >240 mg/dl: sepsis: 17.0%, severe sepsis: 48.2%, septic shock: 45.9%, p = 0.0011). Multivariate analyses showed a significant association of SD levels with critical hypoglycaemia especially for patients in septic shock (p = 0.0197). In addition, SD levels above 20 mg/dl were associated with a significantly higher mortality rate relative to those with SD levels below 20 mg/dl (24% versus 2.5%, p = 0.0195). Patients with severe sepsis and septic shock who were given IIT had a high risk of hypoglycaemia and hyperglycaemia. Among these patients even with a higher target BG level, IIT mandates an increased awareness of the occurrence of critical hypoglycaemia, which is related to the severity of the septic episode.
登录
查看更多内容
影响因子：
120.7
作者：
LEGALL, JR;LEMESHOW, S;SAULNIER, F
通讯作者：
SAULNIER, F
影响因子：
8.9
作者：
Krinsley, JS
通讯作者：
Krinsley, JS
影响因子：
158.5
作者：
Van den Berghe, G;Wilmer, A;Bouillon, R
通讯作者：
Bouillon, R
影响因子：
--
作者：
Reinhart, K;Brunkhorst, F;Werdan, K
通讯作者：
Werdan, K
影响因子：
8.8
作者：
Ali NA;O'Brien JM Jr;Dungan K;Phillips G;Marsh CB;Lemeshow S;Connors AF Jr;Preiser JC
通讯作者：
Preiser JC