肝脏移植患者术后血糖变异性与ICU内谵妄的相关性研究

程江丽; 董美玲; 张中伟; 廖雪莲; 杨家印; 康焰

doi:10.12182/20200560202

肝脏移植患者术后血糖变异性与ICU内谵妄的相关性研究

Association of Glucose Variability and ICU Delirium of Patients after Liver Transplantation

摘要

摘要:
目的研究肝脏移植患者术后血糖变异性与在重症监护室（ICU）发生谵妄的相关性。
方法回顾性纳入2016年8月−2018年12月期间肝脏移植术后入住ICU的患者，根据是否发生ICU内谵妄将患者分为两组，采集患者指尖血，采用多因素logistic回归进行组间血糖变异性〔以血糖不稳定指数(GLI)作为血糖变异性的参数〕的比较，并运用Cochran-Armitage趋势检验分析血糖变异水平和谵妄发生率之间的线性关系。
结果研究共纳入242例患者，其中ICU内谵妄发生率为14.9%（36/242）。多因素logistic回归分析发现血糖变异性是肝移植患者术后ICU内谵妄的独立危险因素（P=0.045)，结果提示谵妄在血糖变异性较高的患者中更为常见（GLI第四分位组 vs. 第一分位组，比值比5.283, 95%可信区间：1.092～25.550, P=0.038），Cochran-Armitage趋势检验分析发现血糖变异性水平和ICU谵妄率之间存在线性关系，随着血糖变异性水平增加，患者ICU内谵妄发生风险显著增加（P<0.001）。
结论血糖变异性增加是肝移植术后患者ICU内谵妄的独立危险因素。

Abstract:
Objective To study the association of glucose variability and ICU delirium of patients after liver transplantation.
Methods This was a retrospective, single-center cohort study. Patients who admitted to ICU after liver transplantation during Aug. 2016 to Dec. 2018 were enrolled. They were divided into two groups accoding to whether they had delirium in ICU. Multivariate logistic regression analysis model was used to analyze the relationship between glucose variability and ICU delirium, and Cochran-Armitage trend test was used to analyze the linear relationship between blood glucose variability levels and the incidence of delirium.
Results A total of 242 patients were enrolled, among them, 36 patients had delirium. The occurrence rate of delirium was 14.9% (36/242). Results indicated that glucose variability was an independently risk factor of ICU delirium for liver transplant patients (P=0.045), and delirium was more common in patients with higher glucose variability (fourth quartile vs. first quartile, odds ratio=5.283, 95% confidence interval: 1.092～25.550, P=0.038). Results of Cochran-Armitage trend test indicated that there was a linear relationship between blood glucose variability level and ICU delirium rate, with the increase of glucose variability level, the risk of ICU delirium was increased too (P<0.001).
Conclusion Glucose variability was an independently risk factor of ICU delirium in liver transplantation patients.

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