分析引起重度烧伤患者早期应激高血糖的危险因素，并总结危险因素与患者预后的关系。

收集2014年5月至2017年3月延安市人民医院骨科78例重度烧伤患者为研究对象，根据入院72 h血糖计算平均血糖波动幅度(MAGE)，并分为低值组(MAGE<3.3 mmol/L, n＝18)、中值组(3.3 mmol/L≤MAGE<5.5 mmol/L, n＝37)、高值组(MAGE≥5.5 mmol/L, n＝23)，比较3组患者一般资料，如性别、年龄、体重、烧伤病因、格拉斯哥昏迷评分(GCS)、呼吸道烧伤情况、烧伤总面积、急性生理与慢性健康评估(APACHE)Ⅱ评分等，并比较生化指标，如降钙素原(PCT)、C反应蛋白(CRP)、动脉血二氧化碳分压(PaCO₂)，统计病死例数、并发症发生情况。计数资料多组间比较使用χ²检验；计量资料多组间比较采用方差分析，两组间比较采用LSD法；采用多因素logistic回归分析应激性高血糖的诱发因素，对生存曲线行Log-rank检验，判断MAGE与预后的关系。

高值组PCT、CRP、烧伤总面积依次为(9.2±1.8) ng/mL、(58.3±10.6) mg/L、(76.7±15.3)%总体表面积(TBSA)，均显著高于中值组[(6.7±1.3) ng/mL、(42.5±8.7) ng/mL、(65.4±13.5) %TBSA]、低值组[(5.3±1.2) ng/mL、(37.4±7.9) ng/mL、(62.7±12.4) %TBSA]，差异均有统计学意义(t_中值组＝6.238、6.286、2.995，t_低值组＝7.909、6.978、3.153；P值均小于0.05)；且高值组APACHE Ⅱ评分、GCS依次为(22.1±4.3)、(13.5±2.7)分，均显著高于低值组(17.5±3.4)、(9.4±2.1)分，差异均有统计学意义(t＝3.716、5.304，P值均小于0.05)；CRP、PCT、烧伤总面积均是影响患者早期应激性高血糖的独立危险因素(P值均小于0.05)；低值组、中值组、高值组90 d内存活率分别为94.4%(17/18)、86.5%(32/37)、69.6%(16/23)，MAGE预测患者预后的受试者工作特征(ROC)曲线面积为0.825，最佳阈值为4.8 mmol/L，对病死预测的灵敏度、特异度分别为86.8%、87.9%；组间比较，高值组感染、急性应激性溃疡发生率依次为82.6%、78.3%，均显著高于低值组(22.2%、33.3%)、中值组(51.4%、45.9%)，差异均有统计学意义(χ_感染²＝14.951、5.967, χ_{急性应激性溃疡}²＝8.398、6.064; P值均小于0.017)。

重度烧伤患者早期应激性高血糖水平与炎性因子及烧伤面积有关，且早期应激血糖越高，其预后越差，早期应激性高血糖可作为评估患者预后的指标之一。

To analyze the risk factors for early stress hyperglycemia in patients with severe burn and the relationship between the risk factors and the prognosis.

Seventy-eight patients with severe burn who were admitted to Department of Orthopedics, Yan′an People′s Hospital during May 2014 to March 2017 were selected as the subjects. The mean amplitude of glycemic excursions(MAGE) was calculated according to the blood glucose in 72 h after admission. The patients were divided into low value group (MAGE<3.3 mmol/L, n=18), median value group (3.3 mmol/L≤MAGE<5.5 mmol/L, n=37) and high value group (MAGE≥5.5 mmol/L, n=23) according to the calculated value. The general data, such as gender, age, weight, causes of burn, Glasgow coma scale (GCS), respiratory tract burn, total area of burn and acute physiology and chronic health evaluation (APACHE) Ⅱscore were compered. Biochemical indexes, such as procalcitonin, C-reactive protein (CRP) and arterial partial pressure of CO₂(PaCO₂) of the three groups were compared, too. The number of death cases and the incidence of complications were statistically analyzed. The enumeration data in multi-group were analyzed by chi-square test, while the measurement data in multi-group were analyzed by analysis of variance. The LSD method were used in the comparison of two groups. The inducing factors of stress hyperglycemia were analyzed by multivariate logistic aggression analysis, and the survival curve was analyzed by Log-rank test to judge the relationship between MAGE and the prognosis.

The PCT, CRP and the total area of burn in the high value group [(9.2±1.8) ng/mL, (58.3±10.6) mg/L, (76.7±15.3) % total body surface area(TBSA)]were significantly higher than those in the median value group [(6.7±1.3) ng/mL, (42.5±8.7) mg/L, (65.4±13.5)% TBSA] and low value group [(5.3±1.2) ng/mL, (37.4±7.9) mg/L, (62.7±12.4)% TBSA], the differences were statistically significant (t_{median value group}=6.238, 6.286, 2.995, t _{low value group}=7.909, 6.978, 3.153; with P values below 0.05). The APACHEⅡ score and GCS of the high value group [(22.1±4.3) and (13.5±2.7) points] were significantly higher than those of the low value group [(17.5±3.4) and (9.4±2.1) points], the differences were statistically significant (t=3.716, 5.304; with P values below 0.05). CRP, PCT and the total area of burn were independent risk factors of early stress hyperglycemia (with P values below 0.05). The 90 d survival rates of the low value group, the median value group and the high value group were 94.4% (17/18), 86.5% (32/37) and 69.6% (16/23), respectively. The area under receiver operating characteristic(ROC) curve of MAGE in predicting the prognosis of patients was 0.825, and the optimal threshold was 4.8 mmol/L. The sensitivity and specificity in predicting death were 86.8% and 87.9%, respectively. The incidence rates of infection and acute stress ulcer in the high value group (82.6%, 78.3%) were significantly higher than those in the low value group (22.2%, 33.3%) and the median value group (51.4%, 45.9%) ( χ _infection²=14.951, 5.967, χ _{acute stress ulcer}²=8.398, 6.064; with P values below 0.017).

The level of stress hyperglycemia in patients with severe burn is related to inflammatory factors and the area of burn. The higher the early stress glucose is, the worse the prognosis is. Early stress hyperglycemia can be used as an indicator for evaluating the prognosis.