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標題: | 院內心跳休止病患之長期血糖、血糖差值與其神經學預後之相關性 The association between long-term glycaemic control, glycaemic gap and neurological outcome of in-hospital cardiac arrest in diabetics: A retrospective cohort study |
作者: | Jin-Lin Chang 張覲麟 |
指導教授: | 陳文鍾(Wen-Jone Chen) |
關鍵字: | 院內心跳休止,心肺復甦術,糖化血色素,血糖差值, In-hospital cardiac arrest,Resuscitation,Blood glucose,HbA1c, |
出版年 : | 2019 |
學位: | 碩士 |
摘要: | 研究背景
現在的急救流程中,對於院內呼吸心跳休止(In-hospital cardiac arrest, IHCA)經復甦後急救的病患,並沒有明確制訂關於目標血糖(Target glucose)的控制。在歐洲急救協會以及美國心臟科協會指引中,雖然有提到關於病患血糖之控制,但仍然著墨不多。此外,經急救恢復自主循環之病人,能出院比例很低,更遑論能恢復良好的神經學預後,恢復獨立或半獨立生活。因此,如何增加心跳休止病患後續之神經學預後,一直是很重要的議題。 而糖化血色素(Glycosalated haemoglobin, HbA1c)是我們臨床上經常使用來檢測糖尿病患者近期血糖控制的指數。在多方的研究中,目前已知病患血糖和其神經學預後有相關性。然而糖化血色素,是否可以應用在心跳休止經急救後復甦病患之血糖調控,以及其神經學預後否有相關,卻沒有相關的文獻探討。因此,本研究擬探討院內心跳休止病患之糖化血色素值、急救後復甦初期的測量血糖值以及其後續神經學預後之關係。 研究方法與結果 我們回溯了2006年至2015年間,單一醫學中心之院內心跳休止之病患共141位,並收集其3個月內之糖化血色素,以及急救後復甦24小時內,最高以及最低血糖值來加以分析。 在141位病患中,其糖化血色素之平均值為7.2%,換算出來的預估血糖平均值(Estimate average glucose, eAG)為160.2mg/dL。如心跳休止之病患之預估血糖值小於196mg/dL(糖化血色素之換算值為 8.5%)時,病患會有比較佳之神經學預後(OR: 5.12; 95% CI: 1.11-23.70; p-value=0.04);當最小之血糖差值差距(Minimum glycaemic gap)小於70mg/dL時,也會有同樣較佳之神經學預後(OR:5.41; 95% CI: 1.41-20.78; p-value = 0.01)。 本研究結果顯示,院內心跳休止經急救後復甦之糖尿病患,其長期血糖調控和神經學預後有關;且病患之糖化血色素也許可以做為該族群後續血糖調控之指標。然而該結果仍然需要後續前瞻性研究來加以驗證。 Aim Resuscitation guidelines do not recommend a target blood glucose (BG) level specifically tailored for diabetics experiencing an in-hospital cardiac arrest (IHCA). The glycosylated haemoglobin (HbA1c) level may be associated with neurological prognosis and used to identify the optimal BG level for diabetic IHCA patients. Methods This study was a retrospective study in a single medical center. Patients with an IHCA between 2006 and 2015 were screened. The estimated average glucose (eAG) level was converted from the HbA1c level measured within three months prior to the IHCA. The minimum glycaemic gap was calculated from the post resuscitation minimum BG level minus the eAG level. Results: A total of 141 patients were included in this study. The mean HbA1c was 7.2% (corresponding eAG: 160.2 mg/dL [8.9 mmol/L]). Multivariable logistic regression analysis indicated an eAG level of less than 196 mg/dL (10.9 mmol/L; corresponding HbA1c: 8.5%) was positively associated with a favourable neurological outcome at hospital discharge (odds ratio [OR]: 5.12, 95% confidence interval [CI]: 1.11–23.70; p-value=0.04). An absolute minimum glycaemic gap of less than 70 mg/dL (3.9 mmol/L) was also positively associated with a favourable neurological outcome (OR: 5.41, 95% CI: 1.41–20.78; p-value=0.01). Conclusion: For diabetic patients, poor long-term glycaemic control correlated with worse neurological recovery following an IHCA. The HbA1c-derived average BG level could be used as a reference point for glycaemic management during the early stage of post-cardiac arrest syndrome. The glycaemic gap could be used to identify the optimal glycaemic range around the reference point. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/74167 |
DOI: | 10.6342/NTU201902681 |
全文授權: | 有償授權 |
顯示於系所單位: | 臨床醫學研究所 |
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