ABSTRACT
Objective To investigate the effects of stress hyperglycemia on prognosis in patients with severe cerebral vascular diseases.Methods A retrospective analysis was conducted.416 patients with severe cerebral vascular diseases confirmed by radiological imaging admitted to intensive care unit (ICU) of Guangdong General Hospital from December 2013 to June 2015 were enrolled.According to the values of randomise blood glucose (RBG) and glycosylated hemoglobin (HbA1c) and diabetes history,the patients were divided into euglycemia group (RBG ＜ 11.1 mmol/L,HbA1c ＜ 0.065,without diabetes history),diabetes group (RBG ≥ 11.1 mmol/L,HbA1c ≥ 0.065,with diabetes history),and stress hyperglycemia group (RBG ≥ 11.1 mmol/L,HbA1c ＜ 0.065,without diabetes history).The nosocomial infection rate,the length of ICU stay and 28-day mortality were compared among the three groups.Survival analysis was performed using Kaplan-Meier method,and multivariate Cox proportional hazard model was used to estimate the risk of death.Results Among 416 patients,there were 40 cases with stress hyperglycemia,46 with diabetes and 330 with euglycemia,with the incidence of stress hyperglycemia of 10.81％ (40/370).The nosocomial infection rates in the stress hyperglycemia group and diabetes group were significantly higher than those of the euglycemia group [55.00％ (22/40),52.17％ (24/46) vs.18.79％ (62/330),both P ＜ 0.01],and the length of ICU stay was significantly longer than that of the euglycemia group (days:16.53 ± 6.26,15.79 ± 8.51 vs.9.23 ± 4.29,both P ＜ 0.01).No significant differences in nosocomial intection rate and length of ICU stay were found between stress hyperglycemia group and diabetes group (both P ＞ 0.05).The 28-day mortality rate in stress hyperglycemia group was significantly higher than that of diabetes group and euglycemia group [47.50％ (19/40) vs.26.09％ (12/46),10.30％ (34/330),P ＜ 0.05 and P ＜ 0.01].It was showed by Kaplan-Meier survival analysis that 28-day cumulative survival rate in stress hyperglycemia group was significantly lower than that of euglycemia group and diabetes group (log-rank =6.148,P =0.043).It was showed by Cox death risk analysis that stress hyperglycemia was the risk factor of death in patients with severe cerebral vascular disease [hazard ratio (HR) =1.53,95％ confidence interval (95％CI) =1.04-1.26,P =0.001].Conclusion The patients with stress hyperglycemia may have a higher 28-day mortality and a poorer prognosis compared with those with diabetes and normal blood glucose in severe cerebral vascular diseases.
ABSTRACT
Objective To study the distribution of pathogenic bacterium and its sensitivity to antibiotic in severe cerebral vascular disease patients with nosocomial pneumonia.Methods Retrospective studies were done in 42 cases of severe cerebral vascular disease patients in neurological intensive care unit (NICU). Secretion from lower respiratory tract was cultivated and done medicine sensitive test at 3 d、4 d、5 d、9 d、16 d after hospitalized,then the etiologic data of nosocomial pneumonia were analyzed.Results Among 42 cases,15 pathogenic microorganisms and 163 strains were cultivated, the fisrt 4 strains were Staphylococcus aureus,Pseudomonas aeruginosa,Klebsiella and Enterobacter cloacae. The results of medicine sensitive test indicated that Gram-negative bacteria was sensitive to Imipenem,and Gram-positive bacteria was sensitive to Vancomycin.Conclusions The main pathogen of nosocomial pneumonia in severe cerebral vascular disease patients may be Staphylococcus aureus,Pseudomonas aeruginosa. Staphylococcus aureus was sensitive to Vancomycin,so Vancomycin can be act as the first choice drug to deal Gram-positive bacteria. Pseudomonas aeruginosa is relatively sensitive to Amikacin and Ciprofloxacin,while Imipenem is the second, but drug fast is to cephalosporins. So the first two antibiotics can be as the experience drugs to deal Pseudomonas aeruginosa.