Diabetes does not influence selected clinical outcomes in critically ill burn patients.
Diabetes does not influence selected clinical outcomes in critically ill burn patients.
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糖尿病不会影响危重烧伤患者的特定临床结果。
DOI：
10.1097/bcr.0b013e31820aaf68
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发表时间：
2011
期刊：
影响因子：
--
通讯作者：
Wade,CharlesE
中科院分区：
文献类型：
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作者：
Dahagam,ChaitanyaK;Mora,Alejandra;Wolf,StevenE;Wade,CharlesE
本研究的目的是评估糖尿病烧伤重症监护室（ICU）患者的血糖控制和临床结果。作者回顾了 4 年来住进烧伤 ICU 的 462 名平民患者。排除标准为年龄<18岁、因皮肤感染入院、记录不完整、军人患者。如果受试者的病历中记录有糖尿病诊断，则他们被标记为糖尿病。否则，他们就被标记为非糖尿病患者。将糖尿病患者 (n = 57) 与非糖尿病患者 (n = 405) 进行比较。通过化学分析获得入院血糖水平。护理点设备提供剩余的葡萄糖值。在烧伤 ICU 中，所有患者的高血糖均接受强化胰岛素治疗，目标血糖水平为 80 至 110 mg/dl。使用Mann-WhitneyU检验、χ2检验和多元回归进行统计分析（P≤.05）。糖尿病患者年龄较大（60 ± 15 vs 44 ± 17 岁），入院血糖较高（196 ± 81 vs 133 ± 52 mg/dl）、平均血糖（147 ± 37 vs 122 ± 24 mg/dl）、血糖变异性（30 ± 11 vs 22 ± 11%），且无需 ICU 天数较少（18 ± 12 vs 20 ± 11）。经过多变量回归分析，年龄、损伤严重程度评分、TBSA、入院血糖和平均血糖显着影响无呼吸机天数、无 ICU 天数和无住院天数。血糖变异性仅与住院天数相关。年龄、损伤严重程度评分和 TBSA 显着影响死亡率，而先前诊断的糖尿病与任何临床结果无关。糖尿病烧伤ICU患者入院血糖较高，血糖更难控制。先前诊断的糖尿病不会影响危重烧伤患者的临床结果。
The purpose of this study was to evaluate glucose control and clinical outcomes in diabetic burn intensive care unit (ICU) patients. The authors reviewed 462 civilian patients admitted to the burn ICU over 4 years. Exclusion criteria were age <18 years, admission because of skin infection, incomplete records, and military patients. Subjects were labeled as diabetic if they had a diagnosis of diabetes documented in their medical records. Otherwise, they were labeled as nondiabetic. Diabetic patients (n = 57) were compared with nondiabetic patients (n = 405). Admission glucose levels were obtained from chemistries. Point-of-care devices provided the remaining glucose values. While in the burn ICU, hyperglycemia for all patients was treated using intensive insulin therapy with a target blood glucose level of 80 to 110 mg/dl. Mann-WhitneyUtest, χ2test, and multivariate regressions were used for statistical analysis (P≤ .05). Diabetic patients were older (60 ± 15 vs 44 ± 17 years) with higher admission glucose (196 ± 81 vs 133 ± 52 mg/dl), mean glucose (147 ± 37 vs 122 ± 24 mg/dl), glucose variability (30 ± 11 vs 22 ± 11%), and fewer ICU-free days (18 ± 12 vs 20 ± 11). After multivariate regression analyses, age, injury severity score, TBSA, admission glucose, and mean glucose significantly affected the number of ventilator-free days, ICU-free days, and hospital-free days. Glucose variability was associated with hospital-free days only. Age, injury severity score, and TBSA significantly influenced mortality, whereas a preexisting diagnosis of diabetes was not associated with any clinical outcomes. Admission blood glucose is higher, and blood glucose is more difficult to control in diabetic burn ICU patients. A preexisting diagnosis of diabetes does not influence clinical outcomes in critically ill burn patients.