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저체온요법을 시행 받은 병원 외 심정지 환자들의 저체온요법 동안 혈당의 변화와 혈당과 예후의 관계

The Changing Pattern of Blood Glucose Levels and Its Association with In-hospital Mortality in the Out-of-hospital Cardiac Arrest Survivors Treated with Therapeutic Hypothermia

정용훈|문정미|전병조|이병국|정경운|류현호|이형연|김기태|이거성
대한중환자의학회 (The Korean Society Of Critical Care Medicine)|2012.11|Acute and Critical Care|제27권 제4호|pp. 255-262

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참고문헌

키워드

glucosemortality.heart arrestinduced hypothermia

초록

Background: The aim of this study was to analyze the dynamics of blood glucose during therapeutic hypothermia (TH) and the association between in-hospital mortality and blood glucose in out-of-hospital cardiac arrest survivors (OHCA) treated with TH. Methods: The OHCA treated with TH between 2008 and 2011 were identified and analyzed. Blood glucose values were measured every hour during TH and collected. Mean blood glucose and standard deviation (SD) were calculated using blood glucose values during the entire TH period and during each phase of TH. The primary outcome was in-hospital mortality. Results: One hundred twenty patients were analyzed. The non-shockable rhythm (OR = 8.263, 95% CI 1.622－42.094, p = 0.011) and mean glucose value during induction (OR = 1.010, 95% CI 1.003－1.016, p = 0.003) were independent predictors of in-hospital mortality. The blood glucose values decreased with time, and median glucose values were 161.0 (116.0－228.0) mg/dl, 128.0 (102.0－165.0) mg/dl, and 105.0 (87.5－129.3) mg/dl during the induction, maintenance, and rewarming phase, respectively. The 241 (180－309) mg/dl of the median blood glucose value before TH was significantly lower than 183 (133－242) mg/dl of the maximal median blood glucose value during the cooling phase (p ＜ 0.001). Conclusions: High blood glucose was associated with in-hospital mortality in OHCA treated with TH. Therefore, hyperglycaemia during TH should be monitored and managed. The blood glucose decreased by time during TH. However, it is unclear whether TH itself, insulin treatment or fluid resuscitation with glucose-free solutions affects hypoglycaemia.

Abstract

Background: The aim of this study was to analyze the dynamics of blood glucose during therapeutic hypothermia (TH) and the association between in-hospital mortality and blood glucose in out-of-hospital cardiac arrest survivors (OHCA) treated with TH. Methods: The OHCA treated with TH between 2008 and 2011 were identified and analyzed. Blood glucose values were measured every hour during TH and collected. Mean blood glucose and standard deviation (SD) were calculated using blood glucose values during the entire TH period and during each phase of TH. The primary outcome was in-hospital mortality. Results: One hundred twenty patients were analyzed. The non-shockable rhythm (OR = 8.263, 95% CI 1.622－42.094, p = 0.011) and mean glucose value during induction (OR = 1.010, 95% CI 1.003－1.016, p = 0.003) were independent predictors of in-hospital mortality. The blood glucose values decreased with time, and median glucose values were 161.0 (116.0－228.0) mg/dl, 128.0 (102.0－165.0) mg/dl, and 105.0 (87.5－129.3) mg/dl during the induction, maintenance, and rewarming phase, respectively. The 241 (180－309) mg/dl of the median blood glucose value before TH was significantly lower than 183 (133－242) mg/dl of the maximal median blood glucose value during the cooling phase (p ＜ 0.001). Conclusions: High blood glucose was associated with in-hospital mortality in OHCA treated with TH. Therefore, hyperglycaemia during TH should be monitored and managed. The blood glucose decreased by time during TH. However, it is unclear whether TH itself, insulin treatment or fluid resuscitation with glucose-free solutions affects hypoglycaemia.

참고문헌 (30)

  1. Deakin CD, "European Resuscitation Council Guidelines for Resuscitation 2010 Section 4. Adult advanced life support", Resuscitation, 81, pp.1305~1352 (2010)
  2. Langhelle A, "In-hospital factors associated with improved outcome after out-of-hospital cardiac arrest. A comparison between four regions in Norway", Resuscitation, 56, pp.247~263 (2003)
  3. Müllner M, "Blood glucose concentration after cardiopulmonary resuscitation influences functional neurological recovery in human cardiac arrest survivors", J Cereb Blood Flow Metab, 17, pp.430~436 (1997)
  4. 이흥범, "중증 질환에서 호르몬의 변화", 대한중환자의학회지, 25(3), pp.123~129 (2010), 대한중환자의학회
  5. Preiser JC, "A prospective randomised multi-centre controlled trial on tight glucose control by intensive insulin therapy in adult intensive care units: the Glucontrol study", Intensive Care Med, 35, pp.1738~1748 (2009)
  6. Wiener RS, "Benefits and risks of tight glucose control in critically ill adults: a meta-analysis", JAMA, 300, pp.933~944 (2008)
  7. Hermanides J, "Glucose variability is associated with intensive care unit mortality", Crit Care Med, 38, pp.838~842 (2010)
  8. Escolar JC, "Effect of low temperatures on glucose-induced insulin secretion and ionic fluxes in rat pancreatic islets", J Endocrinol, 115, pp.225~231 (1987)
  9. Helman A, "Glucagon and insulin secretion and their biological activities in hypothermic rats", Endocrinology, 115, pp.1722~1728 (1984)
  10. Peberdy MA, "Part 9: post-cardiac arrest care: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care", Circulation, 122(18), pp.S768~S786 (2010)
  11. Oksanen T, "Strict versus moderate glucose control after resuscitation from ventricular fibrillation", Intensive Care Med, 33, pp.2093~2100 (2007)
  12. Cueni-Villoz N, "Increased blood glucose variability during therapeutic hypothermia and outcome after cardiac arrest", Crit Care Med, 39, pp.2225~2231 (2011)
  13. Nielsen N, "Hypothermia Network: Outcome, timing and adverse events in therapeutic hypothermia after out-of-hospital cardiac arrest", Acta Anaesthesiol Scand, 53, pp.926~934 (2009)
  14. Capes SE, "Stress hyperglycaemia and increased risk of death after myocardial infarction in patients with and without diabetes: a systematic overview", Lancet, 355, pp.773~778 (2000)
  15. Stranders I, "Admission blood glucose level as risk indicator of death after myocardial infarction in patients with and without diabetes mellitus", Arch Intern Med, 164, pp.982~988 (2004)
  16. Nielsen N, "Hypothermia Network: Adverse events and their relation to mortality in out-of-hospital cardiac arrest patients treated with therapeutic hypothermia", Crit Care Med, 39, pp.57~64 (2011)
  17. Van den Berghe G, "Intensive insulin therapy in the medical ICU", N Engl J Med, 354, pp.449~461 (2006)
  18. van den Berghe G, "Intensive insulin therapy in critically ill patients", N Engl J Med, 345, pp.1359~1367 (2001)
  19. NICE-SUGAR Study Investigators, "Intensive versus conventional glucose control in critically ill patients", N Engl J Med, 360, pp.1283~1297 (2009)
  20. 장지용, "치료적 저체온요법을 시행한 병원전 심정지 환자에서 연속 측정한 혈당치와 신경학적 예후", 대한응급의학회지, 22(2), pp.142~150 (2011), 대한응급의학회
  21. Ali NA, "Glucose variability and mortality in patients with sepsis", Crit Care Med, 36, pp.2316~2321 (2008)
  22. Krinsley JS, "Glycemic variability: a strong independent predictor of mortality in critically ill patients", Crit Care Med, 36, pp.3008~3013 (2008)
  23. Monnier L, "Activation of oxidative stress by acute glucose fluctuations compared with sustained chronic hyperglycemia in patients with type 2 diabetes", JAMA, 295, pp.1681~1687 (2006)
  24. Quagliaro L, "Intermittent high glucose enhances apoptosis related to oxidative stress in human umbilical vein endothelial cells: the role of protein kinase C and NAD(P)H-oxidase activation", Diabetes, 52, pp.2795~2804 (2003)
  25. Risso A, "Intermittent high glucose enhances apoptosis in human umbilical vein endothelial cells in culture", Am J Physiol Endocrinol Metab, 281, pp.E924~E930 (2001)
  26. Escolar JC, "Effect of low temperatures on glucose-induced insulin secretion and glucose metabolism in isolated pancreatic islets of the rat", J Endocrinol, 125, pp.45~51 (1990)
  27. Sasaki Y, "Effects of cold exposure on insulin and glucagon secretion in sheep", Endocrinology, 111, pp.2070~2076 (1982)
  28. Lehot JJ, "Glucose homeostasis. Comparison between hypothermic and normothermic cardiopulmonary bypass", Chest, 102, pp.106~111 (1992)
  29. Bernard SA, "Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia", N Engl J Med, 346, pp.557~563 (2002)
  30. Zhao QJ, "Mild hypothermia therapy reduces blood glucose and lactate and improves neurologic outcomes in patients with severe traumatic brain injury", J Crit Care, 26, pp.311~315 (2011)

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