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目的:探讨低血糖事件与脓毒血症合并应激性高血糖患者死亡率增加之间的相关性及相应机制。方法:纳入我院ICU住院的脓毒血症合并应激性高血糖患者为研究对象,予强化胰岛素治疗并监测血糖,按患者的血糖浓度分成3组:正常血糖组(高于3.9 mmol/L),轻度低血糖组(2.3-3.9 mmol/L)和重度低血糖组(低于2.3 mmol/L);分别测定各组活性氧自由基(ROS)水平、丙二醛(MDA)水平、超氧化物歧化酶(SOD)活性、谷胱甘肽(GSH)水平,并观察各组患者的30天死亡率。结果:三组的30天死亡率、ROS水平及MDA水平均为正常血糖组<轻度低血糖组<重度低血糖组,但轻度低血糖组与重度低血糖组间MDA水平差别无统计学意义(P>0.05);三组的SOD活性及GSH水平均为为正常血糖组>低度低血糖组>重度低血糖组,差别有统计学意义(P<0.05)。结论 :脓毒血症合并应激性高血糖患者发生低血糖事件时患者死亡率增加,并且与低血糖的程度相关;这种现象的产生可能与氧化应激损伤机制相关。
Objective: To investigate the correlation between hypoglycemic events and the increase of mortality in patients with sepsis and stress hyperglycemia. Methods: Patients with ICU hospitalized with sepsis and stress hyperglycemia were enrolled in this study. Patients undergoing intensive insulin therapy and blood glucose monitoring were divided into 3 groups according to their blood glucose levels: normal glucose group (higher than 3.9 mmol / L ), Mild hypoglycemia group (2.3-3.9 mmol / L) and severe hypoglycemia group (less than 2.3 mmol / L). The level of reactive oxygen species (ROS), malondialdehyde (MDA) Superoxide dismutase (SOD) activity, glutathione (GSH) levels, and 30-day mortality in each group were observed. Results: The 30-day mortality, ROS level and MDA level of the three groups were normal blood glucose group 0.05). The activity of SOD and the level of GSH in the three groups were all in the normal blood glucose group> low hypoglycemia group> severe hypoglycemia group, the difference was statistically significant (P <0.05). CONCLUSIONS: Patients with sepsis and stress hyperglycemia are associated with an increased incidence of hypoglycaemia and are associated with the degree of hypoglycemia; this phenomenon may be related to the mechanism of oxidative stress injury.