危重患者血糖管理的实施与安全性评价  

Efficiency and safety evaluation of glucose control in critically ill patients

作　　者：何伟[1] 刘杨[1] 李彤[1] 周华[1] 侯静[1] 张彤彦[1] 赵栋[1] 许媛[1] 

机构地区：[1]首都医科大学附属北京同仁医院ICU,100730

出　　处：《中国危重病急救医学》2009年第5期311-314,共4页Chinese Critical Care Medicine

摘　　要：目的评价计算机程序化血糖控制方案的有效性及安全性。方法回顾性分析2005年6月～2007年12月收入北京同仁医院中心重症监护病房（ICU）的患者，根据目标血糖控制水平分为A组（血糖控制目标4．4～6．1mmol／L，857例）和B组（血糖控制目标7．3～8．3mmol／L，894例），用自行制定的计算机程序化血糖管理方案进行血糖管理，记录并追踪两组患者血糖控制情况。结果共对1751例患者的26222次血糖值进行分析。结果显示：A、B两组患者平均血糖分别为（5．99士0．54）mmol／L和（7．43±0．84）mmol／L，均控制在目标血糖范围内。A、B两组低血糖（〈3．3mmol／L）发生率分别为1．65％（197／11933）和1．04％（149／14289）；而严重低血糖（〈2．2mmol／L）发生率仅为0．07％（8／11933）和0．12％（17／14289），无低血糖相关不良影响发生。在亚组分析中，两组内接受肠内营养（EN）患者的血糖达标率（A组38．77％，B组19．15％）显著低于接受全胃肠外营养（TPN）的患者（A组50．81％，B组23．40％，P均〈0．01）；且两组接受EN患者高血糖（〉8．3mmol／L）发生率（A组13．68％，B组38．61％）均显著高于TPN患者（A组8．77％，B组29．05％，P均〈0．01）。低血糖发生率与患者接受营养支持的方式（EN或TPN）无明显相关。结论在本程序化血糖控制方案指导下实现了ICU患者目标指导下的血糖控制，安全、有效，减少了低血糖的发生和血糖检测次数。但本方案对于控制EN期间血糖方面尚存在欠缺，需进一步完善。Objective To evaluate the efficiency and safety of the computerized glucose control protocol in critically ill patients. Methods The patients who were admitted to intensive care unit （ICU） from June 2005 through December 2007 were retrospectively analyzed. Based on the glucose-control target, patients were divided into two groups： group A （target range was 4. 4 6.1 mmol/L, 857 cases）; group B （target range was 7.3- 8.3 mmol/L, 894 cases）. The computerized protocol of glucose management was applied for blood glucose controlling. Results A total of 1 751 patients were enrolled, and 26 222 recorded data were analyzed. The mean blood glucose was （5.99 ±0.54） mmol/L and （7.43 ± 0. 84） retool/L, respectively, and both of them were controlled within the target range. The incidence of hypoglycemia （~3.3 mmol/L） was 1.65% （197/11 933） in group A and 1.04% （149/14 289） in group B. The incidence of severe hypoglycemia （〈2.2 mmol/L） was 0. 07% （8/11 933） and 0. 12% （17/14 289） respectively. No adverse events occurred. The number of patients in whom glucose-control target rate was reached w.as less in patients receiving enteral nutrition （EN, group A 38.77%, group B 19.15%） than those with total parenteral nutrition （TPN） in both two groups （group A 50. 81%, group B 23.40%, both P〈 0. 01）. However, hyperglycemia （〉8.3 mmol/L） incidence in EN patients （group A 13.68%, group B 38.61%） was higher than that in TPN patients （group A 8.77%, group B 29.05%, both P〈0. 01）. No significant correlations were found between hypoglycemia and nutrition support methods （EN or TPN）. Conclusion Blood glucose levels could be controlled effectively and safely within a target range without significant increase in the incidence of hypoglycemia, whereas number of determination is decreased, by using the computerized glucose control protocol. However, our protocol needs further improvement, especially in EN patients.

关 键 词：程序化血糖控制方案 危重症 血糖控制 营养支持 应激性高血糖 低血糖 有效性 安全性 

分 类 号：R686[医药卫生—骨科学]