棋牌大全下载安装

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                              1. 当前位置: 代写一篇论文多少钱 > 医学论文 > 体外循环术后患者发生应激性高血糖与预后相关性

                                体外循环术后患者发生应激性高血糖与预后相关性

                                时间:2018-12-27 10:46作者:黄润 戴垚 张婷婷
                                本文导读:这是一篇关于体外循环术后患者发生应激性高血糖与预后相关性的文章,无糖尿病史的患者,受到创伤等应激后,随机两次以上测定血糖水平,其空腹血糖≥7.00mmol/L或随机血糖≥11.10mmol/L,即可诊断为应激性高血糖(stress-induced hyperglycemia,SHG)。

                                  摘    要: 棋牌大全下载安装目的 分析体外循环术后患者应激性高血糖(SHG)预后的影响因素,为后续优化SHG应对流程,形成闭环式处理方案奠定基础。方法 收集经体外循环手术患者资料,内容包括患者一般资料、预后指标、患者目标血糖值达标时间等。采用描述性分析、χ2检验、方差分析等进行预后分析。结果 本研究共纳入368例经体外循环术后患者,其中SHG患者224例(60. 87%)。患者首次达到目标血糖值(<11. 10mmol/L)平均时间为(15. 00±1. 20) h,72小时内再次和三次发生SHG患者分别额外需要(8. 00±1. 10) h和(6. 00±0. 90) h达到目标血糖值。发生SHG(术后首次血糖值≥11. 10mmol/L)患者死亡率高于无SHG患者(血糖值<11. 10mmol/L),在心律失常、肺部感染、乳酸升高、肾功能衰竭、低血糖等并发症发生率、监护时长、机械通气时长、住院费用等方面均不同程度高于无SHG患者(P <0. 05)。结论 体外循环术后SHG发生率高,容易反复,预后较差。制定合理措施、选择合适管控流程、配合培训开展将有利于SHG控制。

                                  关键词: 体外循环; 应激性高血糖; 预后;

                                  WUTANGNIAOBINGSHIDEHUANZHE,SHOUDAOCHUANGSHANGDENGYINGJIHOU,SUIJILIANGCIYISHANGCEDINGXUETANGSHUIPING,QIKONGFUXUETANG≥7.00mmol/LHUOSUIJIXUETANG≥11.10mmol/L,JIKEZHENDUANWEIYINGJIXINGGAOXUETANG(stress-induced hyperglycemia,SHG)[1]。JUTONGJI,60%~70%JINGTIWAIXUNHUANXINZANGSHUHOUHUANZHEYIFASHG[2]。DUOXIANGYANJIUXIANSHISHGRONGYIYOUFAZHISIXINGXINLVSHICHANG、ZENGJIAJITIGANRAN,HUXIGONGNENGBUQUANDENGBINGFAZHENG,SHIYINGXIANGXINZANGSHOUSHUJINQIHEYUANQIYUHOUDEDULIWEIXIANYINSU[3]。MUQIAN,LINCHUANGSHANGWEIXINGCHENGGUIFAN、XITONGDESHGGUANLIDIAOKONGMOSHI,HEZHONGXUETANGMUBIAOZHIJIGUANKONGFANGANGENGSHIYONGYUTIWAIXUNHUANSHUHOUHUANZHEYIJIUCUNZAIZHENGYI。HUSHIZUOWEILINCHUANGYIXIAN,ZHUNQUEPINGGU、ZAOQIFAXIAN、XIETONGYISHENGJIJICHULI,DUIYUYUFANGHEKONGZHISHGJINZHANJUYOUZHONGYAOYIYI。YINCI,LEJIETIWAIXUNHUANSHUHOUHUANZHEFASHENGSHGYUHUANZHEYUHOUDEXIANGGUANXING,YOUZHUYUHOUXUDIAOKONGFANGANDEHELIHUAZHIDINGJIYINGYONG,JINYIBUWANSHANLINCHUANGHULISHIJIAN,CONGERJIANGDITIWAIXUNHUANSHUHOUHUANZHESHGFASHENGLV,CUJINHUANZHESHUHOUANQUAN。

                                  1、 资料与方法

                                  1.1、 一般资料:

                                  CHOUQU2017NIAN1YUEZHI12YUEBENYUANXINXIONGWAIKEJIANHUSHISHOUZHIDETIWAIXUNHUANSHUHOUHUANZHEGONG368LI。NARUBIAOZHUN:(1)TIWAIXUNHUANXINZANGSHUHOUBINGFASHGDECHENGRENHUANZHE;(2)HUANZHEJIASHUQIANSHUZHIQINGTONGYISHU。PAICHUBIAOZHUN:(1)YIZHIDETANGNIAOBINGHUANZHE、JIAZHUANGXIANXIANGGUANJIBINGJIQITANEIFENMIXITONGJIBING;(2)JIMANXINGYIXIANYANHUANZHE;(3)SHUQIANYINGYONGTANGPIZHIJISUZHE;(4)GANSHENGONGNENGYANZHONGZHANGAIZHE;(5)SHUQIANMINGQUEGANRANHUANZHE。GENJUMEIGUOTANGNIAOBINGXIEHUIDUIYUANNEIGAOXUETANG(≥7.00mmol/L)DEFENLEIBINGJIEHELINCHUANGSHIJIAN,ANXUETANGZHIFENWEISIZU:QIZHONG<7.00mmol/LZU;7.00~11.10mmol/LZU;11.10~20.00mmol/LZU;≥20.00mmol/LZU[4]。<7.00mmol/LZUYU7.00~11.10mmol/LZUWEIWUSHGZU,LIANGZUFENBIEDAIBIAOXUETANGZHENGCHANGYUXUETANGPIANGAOHUANZHE。11.10~20.00mmol/LZUYU≥20.00mmol/LZUWEISHGZU。

                                  1.2 、方法:

                                  自行设计资料收集表,内容包含:患者一般资料(年龄、体重、既往史、术前血糖值、肝肾功能指标等)、患者目标血糖值达标时间,即<11.10mmol/L(初次达标、72小时内再次达标、三次达标时间)、患者预后指标(监护时长、机械通气时长、住院费用、心律失常、肺部感染等并发症)等。由经培训合格的护士收集患者入监护室72h内数据,以患者术后随机血糖值为测量数据。首次随机血糖值在患者入监护室即刻收集,之后常规每4h收集或根据医嘱动态监测并完成信息记录。
                                 

                                体外循环术后患者发生应激性高血糖与预后相关性
                                 

                                  1.3 、统计学处理:

                                棋牌大全下载安装   CAIYONGEpidataJISPSS 17.0BANRUANJIANJINXINGSHUJUFENXI。JILIANGZILIAOCAIYONG(±s)BIAOSHI,DUOZUJIANBIJIAOCAIYONGFANGCHAFENXI,LIANGLIANGBIJIAOCAIYONGLSDFA;JISHUZILIAOCAIYONGLVBIAOSHI,ZUJIANBIJIAOCAIYONGχ2JIANYAN。P<0.05WEICHAYIYOUTONGJIXUEYIYI。

                                  2 、结果

                                  2.1 、四组患者临床基本资料比较:

                                棋牌大全下载安装   GONGNARU368LIJINGTIWAIXUNHUANSHUHOUHUANZHE,QIZHONGSHGHUANZHE(SHUHOUSHOUCIXUETANGZHI>11.10mmol/L)WEI224LI,FASHENGLVWEI60.87%。QIZHONGCHUCIXUETANG≥20.00mmol/LHUANZHE56LI,FASHENGLV15.22%。224LIHUANZHEZHONGZHENDUANWEIBANMOGUANBIBUQUAN48LI(21.43%)、BANMOXIAZHAI38LI(16.96%)、GUANXINBING54LI(24.11%)、ZHUDONGMAIJIACENG18LI(8.04%)、XINFANGZHANDONG55LI(24.55%)、QITA11LI(4.91%)。SIZUXINGBIE、NIANLING、SHENGAO、TIZHONG、GAOXUEYABINGSHI、SHUQIANKONGFUXUETANG、XUEZHI(ZONGDANGUCHUN、GAOMIDUDANGUCHUN、DIMIDUDANGUCHUN)、GANSHENGONGNENG(NIAOSU、JIGAN)BIJIAOCHAYIWUTONGJIXUEYIYI(P>0.05),JIANBIAO1。

                                  2.2 、患者目标血糖值达标时间:

                                棋牌大全下载安装   224LIFASHENGSHGHUANZHE,SHOUCIDADAOMUBIAOXUETANGZHI(<11.10mmol/L)PINGJUNSHIJIANWEI(15.00±1.20)XIAOSHI。QIZHONG72XIAOSHINEIZAICIFASHENGSHGDEHUANZHEWEI143LI(63.80%),SHENGGAOHOUJING(8.00±1.10)XIAOSHIDADAOMUBIAOXUETANGZHI;72XIAOSHINEIDI3CIFASHENGSHGHUANZHEWEI89LI(39.70%),SHENGGAOHOUJING(6.00±0.90)XIAOSHIDADAOMUBIAOXUETANGZHI。

                                  2.3、 SHG与患者预后指标观察:

                                  368LIHUANZHEZHONG,SIWANG5LI(1.36%),QIZHONG4LIWEISHGHUANZHE,ZHANQUANBUSIWANGRENSHU80%。≥20.00mmol/LZUHUANZHEJIANHUSHIZHANG、JIXIETONGQISHIZHANG、ZHUYUANFEIYONG、XINLVSHICHANG、FEIBUGANRAN、RUSUANSHENGGAO、DIXUETANGFASHENGLVJUNGAOYU<7.00mmol/LZU,CHAYIYOUTONGJIXUEYIYI;SIWANGLV、JIXIETONGQISHIZHANG、XINLVSHICHANG、SHENGONGNENGSHUAIJIE、DIXUETANGFASHENGLVGAOYU7.00~11.10mmol/LZU,CHAYIYOUTONGJIXUEYIYI(P<0.0.5)。11.10~20.00mmol/LZUHUANZHEJIXIETONGQISHIZHANG、XINLVSHICHANG、RUSUANSHENGGAOFASHENGLVJUNGAOYU<7.00mmol/LZU,CHAYIYOUTONGJIXUEYIYI(P<0.0.5),JIANBIAO2。

                                  表1 四组不同血糖值患者临床基本资料比较
                                表1 四组不同血糖值患者临床基本资料比较

                                  表2 四组不同血糖值患者首次SHG血糖值与患者预后指标比较
                                表2 四组不同血糖值患者首次SHG血糖值与患者预后指标比较

                                棋牌大全下载安装   ZHU:YU<7.00mmol/LZUBIJIAO*P<0.05;YU7.00~11.10mmol/LZUBIJIAO△P<0.05

                                  3、 讨论

                                  SrinivasanDENG[5]HUIGUXINGDUILIEYANJIUFAXIAN,SHUHOURUICU24hNEI,54.00%DEHUANZHECHUXIANSHUHOUSHG。ZHANGLIYINGDENG[6]TONGJI200LIXINGGUANZHUANGDONGMAIPANGLUYIZHISHUHUANZHEFASHENGSHUHOUSHGZHAN77.00%。ERBENCIYANJIUFAXIANTIWAIXUNHUANSHUHOUHUANZHEFASHENGSHGDEZHAN60.87%,QIEXUETANGZHIGAOYU20mmol/LDEHUANZHEZHAN15.22%。TONGGUOFENXISHGDADAOMUBIAOXUETANGZHIDESHIJIAN,JIEGUOXIANSHIXUETANGZHIRONGYIFASHENGBODONG,SHGDEZISHENXIAJIANGSUDUJIAOMAN,72XIAOSHINEIZHONGFUFASHENGDEBILIYIJIUJIAOGAO,XUEWAIDESHIJIANDADAOMUBIAOZHI,JISHIYINHUANZHESHUHOUNEIHUANJINGZHUJIANQUXIANGWENDING,ZHONGFUXUETANGSHENGGAOHOUDABIAOSHIJIANDUANYUCHUCISHIJIAN,DANYIRANZENGJIALEBINGFAZHENGDEFENGXIAN。YOUCIKEJIAN,JINGTIWAIXUNHUANSHUHOUHUANZHEFASHENGSHGDEBILVYIJIUJIAOGAO,ZAOQIDEYOUXIAOKONGZHIZHIGUANZHONGYAO。

                                  ZAIYUHOUFANGMIAN,UmpierezDENG[7]FAXIAN,XINFAGAOXUETANGHUANZHEDESIWANGLV16.00%,ERXUETANGZHENGCHANGZHEZHUYUANSIWANGLVJIN1.70%。SHUHOUDIYITIANXUETANGZHIGAOYU8.80mmol/LDEXINXUEGUANSHUHOUHUANZHEDESIWANGLV、GANRANBINGFAZHENG、ZHUYUANSHIJIANYANZHANGJUNYOUXIANZHEXIANGGUANXING(P<0.01)[8]。ZHEIYUBENYANJIUJIEGUOXIANGLEISI。SHGDUIXIN、NAO、SHENGONGNENGJUNJIANGZAOCHENGBUTONGCHENGDUDEYINGXIANG。JIUQIYUANYINKENENGSHIZAIXINZANGSHOUSHUQIJIAN,YOUYUMAZUI、CHUANGSHANG、DIWEN、XUEYEXISHIDENGYINSU,DUIJITIZAOCHENGQIANGLIEDECIJIYOUGUAN。SHGYIYOUFADIANJIEZHIWENLUAN、GANRAN、HUXIGONGNENGBUQUAN、NAOJISHENJINGSUNSHANG,YANZHONGSHIYINQIDUOQIGUANGONGNENGSHUAIJIESHENZHISIWANG。CIWAI,SHGYUHUANZHESHUHOUYIHURENYUANYINGDUIFANGSHIYEYOUYIDINGGUANXI,RUWEINENGZHUNQUE、DONGTAIJIANCEXUETANGBIANHUAQUSHI,JISHICAIQUYOUXIAOCUOSHI,JIANGYINGXIANGXUETANGCHULIXIAOGUO,DAOZHIXUETANGFANFUBODONG,YINGXIANGHUANZHEYUHOU。

                                棋牌大全下载安装   MUQIANGUONEISHGDECHULIRENGYICHUANTONGDEXUETANGKONGZHIMOSHIWEIZHU,JIYOUYISHENGXIADAYIZHUJIANCEXUETANG,HUSHIZHIXING,CIMOSHIBINGWEIDUILIANXU、DONGTAIJIANKONGXUETANGQUSHI,YICHANGXUETANGFASHENGLVJIAOGAO[9]。YINCI,GENJULINCHUANGSHIJIQINGKUANG,XUANZEHUOZHIDINGQINGXIDESHGPINGGU、CHULILIUCHENGFEICHANGYOUBIYAO。

                                  MUQIAN,GUONEIWAIFABIAODEXIANGGUANLIUCHENGFANGANSHANGWEIDACHENGGONGSHI。YIWEICHIZHENGCHANGXUETANG4.50~6.00mmol/LWEIMUBIAODEQIANGHUAYIDAOSUZHILIAO(intensive insulin therapy,IIT)CENGYIDUBEIRENWEISHIZUIJIAZHILIAOFANGAN[10]。2011NIANPattanDENG[11]ZERENWEIMUBIAOXUETANGWEI8.00~10.00mmol/LBIIITGENGNENGJIANGDIZHONGZHONGDUDIXUETANGDEFASHENGLV。MEIGUOTANGNIAOBINGXIEHUIJIANYIDADUOSHUWEIZHONGZHENGBINGRENJIANGXUETANGKONGZHIZAI7.80~10.00mmol/L[4]。2009NIANFABIAOYUXINYINGGELANYIXUEZAZHIDEYIXIANGDAXINGDUOZHONGXINYANJIU(NICE-SUGARYANJIU)RENWEIQIANGHUAYIDAOSUFANGANZENGJIALEDIXUETANGFENGXIAN,HUANZHE90TIANNEISIWANGLV,RENWEIMUBIAOXUETANGZHIYINGYOUSUOTIGAO[12]。ZAILIUCHENGYINGYONGFANGMIAN,YOUXUEZHEQIANGDIAOZHONGZHENGJIANHUDANYUANYINGGENJUZISHENSHIJIQINGKUANGHELIZHIDINGKEXUEDEXUETANGKONGZHIBIAOZHUNJILIUCHENG[13]。KEJIAN,MUQIANZHENDUITIWAIXUNHUANSHUHOUHUANZHEFASHENGSHG,SHANGWUYOUXUANDEGUANKONGFANGANKEZHIJIEYINGYONGYULINCHUANG。GENJUZISHENQINGKUANG,BIJIAO、FENXI、XUANZEHESHIDEFANGANZHIGUANZHONGYAO。WEIBIMIANHULIRENYUANZAISHGLINCHUANGYINGDUISHANGCUNZAIDEBORUO,GUANLIZHEYINGDANGJIAQIANGCIFANGMIANDEPEIXUN。LIUCHENGGUIFANDEYINGYONGYEXUJIEHELINCHUANGYIHURENYUANDEGUIFANHUAJIAOYUYUPEIXUN[14]。

                                  ZONGSHANGSUOSHU,TIWAIXUNHUANSHUHOUHUANZHERONGYIYOUFASHG,SHGJIANGZENGJIAHUANZHEFEIBUGANRAN、SHENGONGNENGSHUAIJIE、DIXUETANGDENGBINGFAZHENG,ZENGJIAHUANZHEJIXIETONGQISHIZHANG、JIANHUSHIZHANG、ZHUYUANFEIYONGDENG。ZHIDINGHELICUOSHI、XUANZEHESHIGUANKONGLIUCHENG、PEIHEPEIXUNKAIZHANJIANGYOULIYUSHGKONGZHI。BENYANJIUWEIHOUXUYOUHUASHGYINGDUILIUCHENG,XINGCHENGBIHUANSHICHULIFANGAN,JINYIBUTIGAOHULIPINGGUCHULINENGLI,JIANGDISHGFASHENGLV,BAOZHANGHUANZHEANQUANTIGONGYIDINGDELILUNJICHU。

                                  参考文献

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                                  [2] Prasad AA,Kline SM,Schuler HG,et al. Clinical and laboratory correlates of excessive and persistent blood glucose elevation during cardiac surgery in nondiabetic patients:a retrospective study[J]. J Cardiothorac Vasc Anesth,2007,21(6):843-846.
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                                棋牌大全下载安装   [14]Kruisselbrink R,Kwizera A,Crowther M,et al. Modified Early Warning Score(MEWS)identifies critical illness among ward patients in a Resource Restricted Setting in Kampala,Uganda:A Prospective Observational Study[J]. PLo S One,2016,11(3):e151408.

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