Effect Of Different Blood Glucose Levels On Prognosis And Infection Of Critically Ill Patients In The ICU

Critically illness patients are often in high stress, stress hyperglycemia is common in the ICU. Blood glucose in critically ill patients could reflect the degree of stress, high level of blood glucose was positively correlated with the critical condition. If stress hyperglycemia is uncontrolled, it will increase the harmful pathological physiology effects of the original disease, affect or delay the rehabilitation, and cause multiple complications,Such as serious infections, MOF and death, etc.High blood glucose can weaken the body's defense response, reduce polymorphonuclear leukocyte mobilization,chemotaxis and phagocytic activity, increased incidence of infection.High blood glucose can stimulate endothelial cell activation, result in microvascular contraction,blood stasis,tissue hypoxia and organ dysfunction. However,it is a vicious cycle that the infection and organ dysfunction can also increase stress hyperglycemia, leading to many rescue measures can not achieve or get the desired effect. In critical disease states,insulin controlling blood glucose levels can reduce the infection incidence and mortality of patients, reduce the risk of complications, But it is currently no uniform standards in which level blood glucose level of critically illness patients should be controlled.:This study is a retrospective analysis on associated with infection 109 cases in the ICU, it explore the infection incidence and prognosis of critically ill patients with different blood glucose levels, the clinical features of infection, and improve understanding of infection with different blood glucose levels of critically ill patients. Thus it provide evidence for glycemic control of critically ill patients.This study is a retrospective analysis on associated with infection 109 cases in the ICU,the standard is time into the ICU≥2 days,excluded standard is time into the ICU<2 days, these are cases with infection into the ICU.According to American Diabetes Association recommended glycemic control points of ICU hospitalized patients,cases of daily average of morning fasting blood glucose to meet the standards were divided into three groups:A group:blood glucose≤6.1 mmol/L,4 cases; B group:blood glucose in 6.1～10 mmol/L,57 cases; C group:blood glucose≥10 mmol/L,48 cases.Cases meting the standard registrate sex, age, time into the ICU, diagnosis, prognosis, Stomach tube, urinary catheter, intravenous catheter, endotracheal intubation or tracheostomy and the duration of invasive procedures,daily morning fasting plasma glucose, insulin using, clinical infection, antibiotic use, discharge culture results, all patients admitted to the ICU were given APACHE II score within the first 24h after according to the disease degree.Diagnosis of nosocomial infection diagnostic is reference standards issued by the Ministry of Health. After analyzing of collected clinical data under the diagnostic standard established:respiratory infections, catheter-related blood stream infections, urinary tract infections,abdominal infections, skin and soft tissue infections.SPSS 13.0 software package was adopted to process and analyze the data.The statistical methods included Peareson test and Kruskal-Wallis H test.1.Among 109 patients in the ICU, A group:blood glucose≤6.1 mmol/L,4 cases; B group:blood glucose in the 6.1-10 mmol/L,57 cases; C group:blood glucose≥10 mmol/L,48 cases. Analyzing age, time into the ICU, indwelling stomach tube time, indwelling catheterization, indwelling deep vein tube time, tracheal intubation time,indwelling tracheotomy time,ventilator time,APACHEⅡscore of three groups. The results show time into the ICU,indwelling stomach tube time, indwelling catheterization, indwelling deep venous catheter time, tracheal intubation time, indwelling tracheotomy time and ventilation time were not statistically different (P> 0.05),age,and APACHEⅡscore were statistically different (P<0.05).2.Infection prevalence and prognosis:three groups of patients were 109 cases, cases of infection occurred were 54 cases, infection rate was 49.54%; cases of MODS were 10 cases, the rate was 9.17%;cases of death were 34 cases, mortality 31.19%.Statistical analysis on three groups of indicators, ignoring the A group, test results of B and C groups showed that the incidence of MODS in both groups was no significant difference (P> 0.05), prevalence and mortality was significant difference(P<0.05),C group infection rate and mortality were high.3.Infections circumstances of different sites:the sites of infection were divided into five categories:respiratory, urinary tract, catheter-related bloodstream infections (CRBSI), abdominal infections, skin and soft tissue infections.The largest number of patients with respiratory tract infections in 47 cases (78.33%),followed by abdominal infection in 5 cases (8.33%),CRBSI in 4 cases (6.67%),urinary tract infection in 3 cases(5.00%), skin and soft tissue infection in 1 case(1.67%).Three groups:A group:the number of respiratory and urinary tract infections is 1 case each; B group: most respiratory infections occurred in 19 cases, followed by CRBSI infection in 3 cases;C group:most respiratory infections occurred in 27 cases, followed by abdominal infection 5 cases. Respiratory infection of the B and C patients were statistically analyzed. Result showed P<0.05,statistically significant difference,C group has a higher incidence of respiratory infection. The other infections of the B and C patients were statistically analyzed.Result showed P>0.05,the difference was not statistically significant.4.Phase spectrum of bacterial pathogens:85 samples of the bacteria isolated can be detected,Which can be detected a variety pathogen in the same patient. The number and constitute of pathogens in the three groups were 2 cases respectively (2.70%),32 cases(43.24%),40 cases (54.05%),and the most G-bacteria were detected. Cases of detected pathogens of B group and C group patients were analyzed statistically. Results showed that detection rates of G+ bacteria and fungi were P> 0.05,the difference was not statistically significant;detection rate of G-bacteria was P <0.05,the difference was statistically significant C group was higher.Submission specimens cultivated isolated 85 pathogens in which the most G-bacteria detection was 43 strains, accounting detection pathogens 50.59%;G+ bacteria detection was 20 strains, accounting detection pathogens 23.53%;fungi was 22 strains, accounting seized out pathogens 25.88%.In pathogens detection,sputum culture detect the most 65 strains, accounting 76.47%, Other cultivated methods were respectively:drain cultured 8,urine culture 6 strains, blood culture,tissue culture and deep vein tube culture were 2 strains each.In cultivate pathogens, G+ bacteria was staphylococcus aureus mainly,11 strains, G-bacteria was pseudomonas aeruginosa mainly,20 strains. Fungi was white Candida mainly,12 strains.In sputum culture,the most G-bacteria was 33 strains, followed G+ bacteria was 16 strains, fungi detected was 16 strains.Three groups, detected pathogens of A group were 2 strains, sputum culture G-was 1 strain, urine culture,fungi was 1 strain.B group:the detected pathogens of sputum culture were 47 strains, followed the drain train were 4 strains;C group:the detected pathogens of sputum culture were 39 strains, followed by urine culture and drain were 4 trains.B group and C group:G+ bacteria were Staphylococcus aureus mainly, G- was bacteria Pseudomonas aeruginosa mainly, fungus was candida albicans mainly.1.The higher blood glucose levels lead to the higher the APACHEⅡscore and the more serious disease in ICU patients.2.The higher blood glucose levels lead to the higher incidence of infection and Mortality rate and the worse prognosis in ICU patients.3.Respiratory infection is the most common, and the higher blood glucose level s lead to the higher the incidence of respiratory infection in ICU patients. 4.The higher blood glucose level lead to the higher G-bacteria infection rate fungi and G+ bacteria infection rates were no difference in ICU patients.5.Spectrum of bacterial infection is no difference in different blood glucose levels, infection bacteria is G-bacteria mainly, followed by fungi, G+bacteria at least; G+ bacteria were Staphylococcus aureus mainly, G- is bacteria Pseudomonas aeruginosa mainly, fungus is candida albicans mainly.6.The blood glucose levels had better control below 10 mmol/L in the ICU and the best control is between 6.1～10 mmol/L...