TPN 투여되는 내과계 중환자에서 고혈당증 발생여부에 의한 치료 결과의 비교

Abstract

Hyperglycemia is common in critically ill patients, even in those without diabetes mellitus. The importance of balancing the serum blood glucose in critically ill patients is also well known. However, there are some reports that patients receiving total parenteral nutrition(TPN) have higher risk of hyperglycemia. This study was designed to observe the incidence of hyperglycemia and evaluate the treatment outcomes of hyperglycemic patients on TPN in a medical ICU. We conducted the retrospective study on the patients who were hospitalized from Jan 2007 to June 2007 in Asan Medical Center, who were on TPN for more than 5 days. The data was collected by medical chart review. We analyzed the components of TPN, total daily calories, serum glucose, liver function test, serum albumin, protein and infection during the initial 7 days of TPN administration. Hyperglycemia was defined as serum glucose level exceeding 150mg/dl for 3 consecutive days in this study. All 147 patients who were administered TPN were analyzed. The patients with diabetes mellitus were excluded(n=31, 21%). The incidence of hyperglycemia within the initial 7 days was 56%(65/116). There were no significant differences in gender, initial APACHE II score, nutritive conditions before receiving TPN, use of mechanical ventilator, administration of insulin and the amount of TPN supply between the hyperglycemic group(n=65) and non-hyperglycemic group(n=51). However, the patients in hyperglycemic group were significantly older than those in non-hyperglycemic group(p=0.005), and initial serum glucose level before receiving TPN was also higher in hyperglycemic group(p=0.021). The infection rates with hyperglycemia showed a tendency to increase in hyperglycemic group(p=0.077). ICU mortality rate was significantly higher in hyperglycemic group, compared to non-hyperglycemic group(p=0.041). In conclusion, hyperglycemia occurred highly in critically ill patients, and the association between TPN and hyperglycemia was not statistically significant. However, it might also be associated with increased mortality