The Present Levels And Influence Factors Of Hypoglycemia In Critically Ill Patients

ObjectiveTo investigate the present level of hypoglycemia in critically ill patients.To explore the influence factors of hypoglycemia in critically ill patients,and to further analyze the effects of hypoglycemia on prognosis of critically ill patients. In order to provide references for clinical intervention in the future.MethodsThe questionnaire was self-designed base on literature review and expert consultation, and the cluster sampling method was used to investigate the prevalence of hypoglycemia in critically ill patients who was admitted to comprehensive ICU of four hospitals during June 2014 to December 2014.The sample were divided into hypoglycemia group and non hypoglycemia group, and analyze the effects of hypoglycemia on prognosis of critically ill patients.SAS 9.3 was used for statistical analysis. Measurement datas were described by number, mean and standard deviation,T text or rank test was used for the comparision of two sanples, the number and percentage of qualitative data were described, and chi-square test was used for comparision between two groups.Logistic regression analysis was for the analysis of the comprehensive influence of all factors on hypoglycemia. P≤0.05 considered to have statistical significance.Results1. The incidence of hypoglycemia in critically ill patients:760 cases of critically ill patients were investigated in this study, there were 136 cases of hypoglycemia, and the incidence of hypoglycemia was 17.89%, there were 25 cases of patients with severe hypoglycemia, the incidence of severe hypoglycemia was 3.29%. Totally 38075 times of blood glucose were monitored, there were 267 times of hypoglycemia, accounted for 0.70%,there were 267 times of severe hypoglycemia, accounted for 0.09%.According to sex, the male and female incidence of hypoglycemia were 18.26%,17.39% respectively. According to age, the incidence of hypoglycemia in patients ≤18 years old, 18~44 years old, 45~59 years old, ≥60 years old were 31.25%, 15.10%, 16.07%, 20.12% respectively. According to nutritional support way, the incidence of hypoglycemia in total parenteral nutrition patients and enteral nutrition patients were 17.89%,17.77% respectively. Patients received glucocorticoid hypoglycemia treatment, their incidence rate of hypoglycemia was 17.44%. Patients received intravenous insulin treatment, their incidence rate of hypoglycemia was 27.41%. According to desease history, patients has history of tumor, diabetes, hypertension, coronary disease, apoplexy, their incidence rate of hypoglycemia were 20.63%, 27.59%, 45.45%, 20.63%, 22.92%, 22.73% respectively. The incidence rate of hypoglycemia in patients occurred stress hyperglycemia was 21.59%. According to APACHE score, APACHEⅡ Ⅱ=15~29, the incidence rate was 57.41%, APACHEⅡ≥30,the incidence rate of hypoglycemia was 57.41%. Patients with sepsis, the incidence rate of hypoglycemia was 32.58%, patients had blood purification, the incidence rate of hypoglycemia was 30.30%, patients has malnutrition, the incidence rate of hypoglycemia was 22.08%, patients with organ failure, the incidence rate of hypoglycemia was 40.85%. According to surgery site,patients had hepatobiliary abdominal surgery, non simple hepatobiliary abdominal surgery, non abdominal surgery, the incidence rate of hypoglycemia were 30.70%, 23.23%, 15.25% respectively. Operation time <5 hours, ≥5 hours, the incidence rate of hypoglycemia were 15.75%, 12.32% respectively. According to surgery type, for emergency patients, limited operation patients, selective operation patients, the incidence rate of hypoglycemia were 25.26%, 20.83%, 16.67% respectively. According to anesthesia method, patients had local anesthesia and general anesthesia, the incidence of hypoglycemia were 30.77%,21.56% respectively. According to the blood glucose control program, the target for glycemic control in 7.8mmol/L ~ 10.0mmol/L, 5.6mmol/L ~ 10.0mmol/L, 6.1mmol/L ~10.0mmol/L, 4.4mmol/L~10mmol/L, the incidence of hypoglycemia were 9.17%, 12.15%, 12.76%, 20.45% respectively. According to hypoglycemia happening time, hypoglycemia occurred during 00:00~02:00、02:00~04:00、04:00~06:00、06:00~08:00、08:00~10:00、10:00~12:00、12:00~14:00、14:00~16:00、16:00~18:00、18:00~20:00、20:00~22:00、22:00~24:00,the incidence rate were 14.98%、5.24%、12.36%、11.24%、10.86%、9.36%、5.62%、8.24%、5.24%、7.12%、2.62、4.49% respectively. According to the consciousness, lucid, coma, sedation, lethargy, dizzy acounted for 49.81%, 26.59%, 13.86%, 5.62%, 4.12%, respectively. When hypolyceima happening, the mechanical ventilation patients accounted for 59.18%, the blood purification patients accounted for 3.75%, and the incidence rate of hypoglycemia in died patients was 22.13%.2. Single factor analysis : insulin venous instilling, low serum albumin history, diabetes history, minimum blood sugar, max blood sugar, stress hyperglycemia, total blood glucose monitoring time, hemoglobin, serum creatinine, APACHEII score, infection, blood purification, malnutrition, organ failure, operation, surgical site, blood glucose control method were related to hypoglycemia in critically patients(P<0.05,but age, sex, occupation, education level, nutrition support way, use of glucocorticoid, admission glucose, tumor, hypertension, coronary heart disease, cerebral apoplexy, ALT,AST, total bilirubin, operation time, operation mode, anesthesia method have no relation to hypoglycemia in critically patients(P>0.05).3.Logistic regression analysis: intravenous nsulin therapy(OR=4.984,3.141~7.906), history of diabetes(OR=0.408,1.711~9.573), stress hyperglycemia(OR=2.806,1.366 ~ 3.186), low serum albumin(OR=1.848,1.006~3.395), serum creatinine(OR=1.049,1.039~1.060), APACHE II score(OR=1.131,1.106 ~ 1.157), sepsis(OR=2.135,1.045~4.363), blood purification(OR=2.409,1.567~3.704), malnutrition(OR=2.200,1.446 ~ 3.346), organ failure(OR=6.744,4.048~11.235), operation(OR=2.525,1.745~3.635) were risk factors. Hemoglobin(OR=0.983,0.972~0.995) and blood glucose control methodsa were protective factors(OR<1).4. Prognosis: The incidence of sepsis, blood purification treatment rate, rate of malnutrition, rate of organ failure, hospitalization expenses, ICU stay time, hospitalization time, 28 day mortality rate in patients with hypoglycemia and non hypoglycemia, which all have statistical significance(P<0.05).Conclusion1.The incidence rate of hypoglycemia in patients with critical illness was 17.89%, the incidence rate of severe hypoglycemia 3.29%,which was high.2. The incidence of hypoglycemia in critically ill patients was a combination of multiple factors, has dangerous and protective factors.3. The incidence of hypoglycemia will affect the prognosis of critically patients.