The Effect Of Different Blood Glucose Targets On Short-term Complication And Prognosis In Critical Ill Patients

Objective: To study the effect of different blood glucose targets on short-term complication and prognosis in critical ill patients. To emphasis the importance of detecting blood glucose and improve clinical treatments with enhancing medical staffs’ attention to blood glucose in critical ill patients in intensive care unit(ICU).Method: 1 Patients and groups:The study was conducted in the second central hospital ICU of Baoding city from September 2013 to February 2015. We chose patients: ①Admitted to ICU for equal or more than 5 days. ② The Acute physiology and chronic health evaluation(APACHE-Ⅱ) score should be equal or more than 8. ③ The random blood glucose levels should be equal or more than 11.1 mmol/l. We did not choose patients who had diabetes and taking glucocorticoid over a long period of time.According to the exclusion criteria and meet the inclusion criteria②③, a total of two hundred thirty patients were included,according to the prospective studies.patients were randomly divided into two groups, The One hundred fifty two patients who ultimately met the inclusion criteria ①②③, group A(76 cases) and group B(76 cases),according to the prospective studies. Blood glucose was detected by fast blood glucose meter(ACCU-CHEK glucose meter). Testing results of blood glucose meter and biochemistry methods of laboratory medicine were compared termly to make sure the accuracy of the fast blood glucose monitoring. Patients in both groups received 0.9% sodium chloride(50 ml) combined with small injection pump of regular insulin(50u) pumped into vein to control blood glucose during the next 24~72 hours. Blood glucose in group A was controlled at 6.0~7.7 mmol/L, while the data in B group was controlled at 7.8~10.0 mmol/L. During treatment, rapid blood sugar was monitored for Q1-4 hours, and then regulating frequency of monitoring blood glucose and pumping speed of regular insulin to keep the blood glucose target in two groups.2 Monitoring parameters:The patients’ average age, APACHE-Ⅱscores, ICU staying time, infection complications(hospital acquired pneumonia, catheter-related bloodstream infection,catheter associated urinary tract infection)catheter related infections, urinary tract infection and pulmonary infection) cases, hypoglycemia complication cases and death cases in the ICU were recorded.All the results were analyzed by SPSS 17.0, measurement data was expressed as mean ± standard deviation( x ± s), comparison between two groups were analyzed by t-test. And enumeration data were analyzed by χ2 test, and values of P<0.05 were considered as statistically significant, which means there was significant difference between two groups.Result: 1 General situation in two groups:There was 76 cases in group A,which including 40 males and 36 females, whose average age was 71.43±12.80(21~93years old). The APACHE-Ⅱscore was 16.95±7.94(8~40 points). There was 76 cases in group B,including 43 males and 33 females, whose average age was 67.93±13.38(11~93years old). The APACHE-Ⅱscore was 16.93±7.87(8~51 points). There was no statistical difference in sex, age and APACHE-Ⅱscore between the two groups(P>0.05, Table 1).2 Complications in two groups:There were 10 infection complications cases occurred in group A, while 13 cases in group B. There was no statistical difference in infection complications incidence in two groups(P>0.05, Table 2). Hospital acquired pneumonia(HAP) was 9 cases in group A, while 11 cases in group B. There were 1 case ventilator associated pneumonia(VAP)and 1 case catheter associated urinary tract infection(CAUTI) in group A. There were 1 case catheter-related bloodstream infection(CRBSI) and 1 case catheter associated urinary tract infection(CAUTI) in group B(Table 2.2). Hypoglycemia complications occurred in group A was 8 cases, while 2 cases in group B. The incidence of hypoglycemia complication in both groups has statistically difference. Blood sugar complication rate was 10.52% in group A, while was 2.63% in group B. The rate of blood sugar complication in group A was obvious higher than that in group B(P<0.05, Table 3).3 Prognosis in two groups: The ICU average staying time in group A was 11.37±8.31 days, while in the group B was 11.88±7.97 days. There was no statistical difference in ICU staying time between the two groups(P>0.05, Table 4). The death was 20 cases in group A and 17 cases in group B. There was no statistical difference at ICU mortality in the two groups(P>0.05, Table 4).Conclusion: 1 Compared with 6.0~7.7mmol/L,the blood glucose controlled at 7.8~10.0mmol/L can improve hypoglycemia complications, but no effect on the infection complications. 2 Compared with 6.0~7.7mmol/L,the blood glucose controlled at 7.8~10.0mmol/L can not reduce ICU stay and improve survival in ICU.