| Summary: | 碩士 === 高雄醫學大學 === 藥學研究所碩士在職專班 === 102 === Background: The beneficial effects of total parenteral nutrition（TPN）in improving the nutrition status of malnourished patients during hospital stays have been well established. Hyperglycemia is a common complication in patients receiving TPN. Recently, many randomized trials and meta-analyses have reported the increased mortality and morbidity rates in patients suffering hyperglycemia. TPN might cause hyperglycemia in patients with no diabetes mellitus past-history. Therefore, we aimed to examine the risk factors associated with hyperglycemia and how they can affect the clinical outcomes in critically ill patients with no history of diabetes mellitus.
Objective: This retrospective study was conducted to determine whether the amount of dextrose from TPN was related to the development of hyperglycemia and the clinical outcome in no diabetes mellitus history patients.
Method: We retrospectively collected the data of the patients receiving TPN in surgical intensive care unit (SICU) between June 2010 and June 2012. The following parameters were analyzed : the patients’ demographic characteristics, blood glucose level, TPN related information (the daily mean, maximum and minimum blood glucose level, related insulin infusion rate, TPN used days), days of ICU stay and mortality .
Results: We enrolled totally 156 patients and divided them into two groups according to their baseline blood glucose of ICU care < 140 mg/dL as the normoglycemia group (n = 63) vs ≧140 mg/dL as the hyperglycemia group (n = 93). During the SICU stayed period, the mean blood glucose levels of hyperglycemic group were significantly increased than normoglycemic group (174.25±40.98 mg/dL vs 152.59±35.18 mg/dL (P < 0.001). There was no significant difference of mortality rate between the two groups, however. Multiple linear regression analysis showed that the mean blood sugar level was related to age, APACH II score, baseline blood glucose, TPN used days and dextrose delivery rate. According to the related analysis, the baseline blood glucose levels increased 1 mg/dL, the averaged blood sugar levels would increase 0.27 mg/dL during the TPN used period (P < 0.001). Furthermore, the TPN administration was raised 1 day, the averaged blood sugar levels would increase 0.60 mg/dL (P = 0.041).
Conclusion: Our study showed that prolonged TPN used days and patients baseline blood sugar might be associated with the development of hyperglycemia risk factor in SICU patients without a history of diabetes mellitus. Our study helps identify the high risk group of hyperglycemia in SICU patients received TPN.
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