早期血糖变化对脓毒性休克患者预后影响

The Impact of Early Blood Glucose Variations on Prognosis in Patients with Septic Shock

摘要: 目的：明确脓毒性休克患者住院死亡的独立危险因素，探究早期不同血糖水平对其临床特征及预后的影响，分析胰岛素干预在合并与不合并糖尿病患者中的差异化效应，为精准血糖管理提供理论依据。方法：采用回顾性队列研究，纳入312例脓毒性休克患者，按24小时平均血糖 ≤ 8 mmol/L分组，结合糖尿病史分层，通过多因素Logistic回归分析危险因素及胰岛素干预效果。结果：机械通气、24小时乳酸升高及乳酸清除率降低是住院死亡独立危险因素(P < 0.05)；24小时平均血糖非独立预测因子。非糖尿病患者胰岛素治疗为保护因素(OR = 0.326, P = 0.030)；糖尿病患者胰岛素使用增加死亡风险(OR = 4.041, P = 0.003)，低血糖为最强危险因素(OR = 15.194, P < 0.001)。结论：脓毒性休克患者血糖管理应依据糖尿病史分层：非糖尿病患者可积极控糖获益，糖尿病患者则应优先防范低血糖，且个体化、强化监测比单一血糖目标更关键。

Abstract: Objective: To identify the independent risk factors of in-hospital death in patients with septic shock, explore the impact of early different blood glucose levels on their clinical characteristics and prognosis, and analyze the differential effect of insulin intervention in patients with and without diabetes, so as to provide a theoretical basis for precise blood glucose management. Methods: A retrospective cohort study was conducted in 312 patients with septic shock, who were divided into two groups according to 24-hour average blood glucose ≤ 8 mmol/L. Combined with the stratification of diabetes history, the risk factors and the effect of insulin intervention were analyzed by multivariate logistic regression. Results: Mechanical ventilation, elevated 24-hour lactate and decreased lactate clearance rate were independent risk factors for in-hospital death (P < 0.05); 24-hour mean blood glucose was not an independent predictor. Insulin therapy was the protective factor in non-diabetic patients (OR = 0.326, P = 0.030); Insulin use in diabetic patients increased the risk of death (OR = 4.041, P = 0.003), and hypoglycemia was the strongest risk factor (OR = 15.194, P < 0.001). Conclusion: Glycemic management in patients with septic shock should be guided by stratification based on diabetes history: non-diabetic patients may benefit from active glucose control, while diabetic patients should prioritize hypoglycemia prevention, with individualized and intensified monitoring being more critical than a single glucose target.