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危急病患者的葡萄糖控制和死亡率
Simon J Finney1, Cornelia Zekveld, Andi Elia
1Adult Intensive Care Unit, Royal Brompton Hospital, London, England.
JAMA
|October 16, 2003
概括
在重症患者中,较高的胰岛素剂量与死亡率的增加有关,不论血糖水平如何. 有效的血糖控制,而不仅仅是胰岛素量,是减少重症监护室 (ICU) 死亡的关键.
科学领域:
- 关键护理医学 关键护理医学
- 内分泌学 在内分泌学.
- 代谢障碍 代谢障碍 代谢障碍
背景情况:
- 高血糖在危急病患者中很常见,包括那些没有糖尿病的患者.
- 积极的血糖控制可能会降低这一患者群的死亡率.
- 死亡率,高血糖控制和胰岛素管理之间的确切关系尚不清楚.
研究的目的:
- 研究血糖水平和胰岛素给药与重症患者死亡率之间的关联.
- 为了确定血糖控制或胰岛素的数量是否对降低死亡率更为关键.
主要方法:
- 一个单一中心的前性观察性研究,涉及531名成人患者,这些患者被送往英国的重症监护室 (ICU).
- 主要终点:ICU死亡率. 二级终点:医院死亡率,ICU和住院时间长度,以及预测死亡风险的葡萄糖值.
- 使用多变量逻辑回归分析来评估胰岛素给药,葡萄糖水平和死亡率之间的关系.
主要成果:
- 集中治疗室和医院的死亡率分别为5.2%和5.7%.
- 增加胰岛素的使用与更高的ICU死亡率显著相关 (OR,每1IU/d增加1.02在111-144 mg/dL葡萄糖).
- 在预测的葡萄糖值为144-200 mg/dL以下,观察到死亡率的好处,这表明血糖控制有好处.
结论:
- 增加胰岛素的使用与ICU死亡率有积极的关联,这与目前的血糖水平无关.
- 在密集胰岛素治疗中观察到的死亡益处可能源于有效的血糖控制,而不是绝对服用的胰岛素量.
- 目标血糖控制,可能低于145 mg/dL,可能比仅仅专注于胰岛素剂量更为关键.
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