| Objective:Blood glucose variability is an independent risk factor for increased mortality in critical patients.Analgesic and sedation can reduce the stress response to a certain extent and reduce blood glucose, reduce blood glucose variability.It is that induce and maintain a low metabolism "dormant" state for a long time, it can reduce all kinds of stress and inflammatory injury, and reduce organ damage to a severe patients.Therefore,this research was to investigate the effect of analgesia and sedation therapy on blood glucose variability and prognosis in patients with severe,and try to acquaintance the insulin, corticosteroids and calorie intake correlated with blood glucose variability in critically ill patients. Objective to investigate the optimal blood glucose control scheme of intensive care unit (ICU).Methods:This study is a retrospective clinical study. Choosing the adult patients who received emergency intensive care units from January 2015 to January 2016,Inclusion Criteria:(2)age≥18;(2)APACHEⅡ≥10;(3)Time of enter ICU >7days;(4)glycosylated emoglobin<6.5%;(5)There is stress hyperglycemia.Exclusion criteria:(1)Patients without impaired fasting insulin (FINS) examination;(2)Patients that diagnosis of severe traumatic brain injury% severe acute pancreatitis and a clear history of diabetes or impaired fasting blood glucose regulation% impaired glucose tolerance.In line with the above requirements in our study.According to the patients admitted to hospital within 7 days whether to give analgesic and sedative treatment is divided into A group (Analgesic and sedative group)and B group(Non analgesia sedation group).Before the treatment began,7 days after treatment, the changes of clinical indicators has been collected:FBG(Fasting blood glucose)、 GHbAlc(glycosylated hemoglobin)、FINS(fasting insulin)、BGSD (standard deviation of blood glucose)、Coefficient of variation of blood glucose (BGCV)、 average blood glucose concentration(BGAve)、insulin、hormone、and energy (calorie) intake.Description and analysis the data using SPSS 18 software.When the data is in accordance with the normality test,measurement data were expressed as mean ±tandard deviation, and the difference between groups was compared with that of independent samples t test;The number and percentage of the count data were described, and the x2 test was used for comparison between groups.In P<0.05, the difference was statistically significant.Results:Within two independent samples t test:the age, body mass index, total energy intake, the total amount of hormones of patients with two groups has no statistically significance difference (P>0.05),the differences ofAPACHE II score was statistically significant (P=0.002),after χ2 test,the difference of blood glucose, glycosylated hemoglobin, HOMA-IR, BGSD, BGCV between two groups of patients before treatment, were not statistically significant,(Table 2).Paired t test:after 7 days,the average blood sugar, HOMA-IR, BGSD, BGCV of A group and B group were reduced compared with the treatment before,the difference was statistically significant (P<0.05) (Table3、Table4).After two independent samples t test:there was no significant difference in blood glucose and glycosylated hemoglobin between the two groups after 7 days (P>0.05), the HOMA-IR, BGSD, BGCV of A is less than the B group.the difference was statistically significant(P< 0.05),(Table5),It showed that the analgesic and sedative treatment can reduce the insulin resistance and diminish the blood glucose variability.In this research,whether the BGSD is less than 1.4 mmol/L is divided into the normal group and the abnormal group (Table 6),after two independent samples t test:the differences of the total energy intake (caloric), total hormone,total insulin between Blood glucose change specificity of normal group and blood glucose variability in abnormal group and were statistically significant(P< 0.05). With two classification Logistic regression analysis at the same time(Table7、Table8);total energy intake (OR=1.10), total hormone(OR=1.78)、total insulin(OR=2.11)are the risk factors to increase the blood glucose variability above,enteral nutrition (OR=0.78) is a protective factor to decrease blood glucose variability.Conclusions:1.Sedative and analgesic therapy can improve insulin resistance in patients with severe.2.Sedative and analgesic therapy can reduce the blood glucose variability in patients with severe.3.In the Patients with severe The insulin, glucocorticoids, calorie intake is the risk factors to increase the Blood glucose variability。... |
PDF Full Text Request