胰岛素输注方案对内科重症监护病房患者血糖控制的作用  

Insulin infusion protocol could improve blood glucose level control in medical intensive care unit

作　　者：彭劲民[1] 翁利[1] 胡小芸[1] 梁建峰[2] 杜斌[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院MICU,100730 [2]北京老年医院ICU

出　　处：《北京医学》2011年第5期403-406,共4页Beijing Medical Journal

摘　　要：目的探讨胰岛素输注方案对内科重症监护病房(MICU)患者血糖控制的作用。方法选择2007年8～10月MICU中需要进行血糖控制的患者分3个阶段进行研究,每个阶段为1个月。3个阶段分别为:①根据医生经验进行血糖控制而无目标血糖值;②根据医生经验进行目标血糖控制(4.5～7.5mmol/L);③根据计算机辅助的胰岛素输注方案进行相同目标的血糖控制。比较3个阶段每日血糖达标时间比例、每日高血糖指数(HGI)、严重低血糖次数比例。结果 3个阶段血糖达标时间比例分别为27.4、30.3、46.0,有显著性差异(P<0.001);第3阶段显著高于第1和第2阶段(P均<0.001)。3个阶段HGI分别为1.52mmol/L、1.30mmol/L、0.25mmol/L,有显著性差异(P<0.001);第3阶段HGI明显低于第1和第2阶段(P均<0.001)。3个阶段发生严重低血糖的次数比例无显著性差异(P=0.877)。结论采用计算机辅助的胰岛素输注方案能更安全、有效地控制MICU患者的血糖水平。Objective To determine whether an insulin infusion protocol could improve the efficacy and safety of glucose level control in medical ICU.Methods The study was performed through three stages in medical ICU：①Physician-initiated insulin infusion without target glucose level.②Physician-initiated insulin infusion with target glucose level（4.5~7.5mmol/L）.③A computer assistant insulin infusion protocol was applied to achieve glycemic control with the same target glucose level as in Stage Ⅱ.Several parameters were compared among the three stages,which included proportion of time to target glucose range,daily hyperglycemic index（HGI）,incidence of measured severe hypoglycemia（2.2mmol/L） and proportion of patient-days when severe hypoglycemia occurred.Results Proportion of time to target glucose range differed significantly among the three stages（27.4%,30.3%,46.0% respectively,P 0.001）,with that in Stage Ⅲ was higher than Stage Ⅰ（P 0.001） and Stage Ⅱ（P 0.001）.There was also significant difference of daily HGI among three stages（1.52mmol/L,1.30mmol/L,0.25mmol/L respctively,P 0.001）,with that in Stage Ⅲ lower than Stage I（P 0.001） and Stage Ⅱ P 0.001）.No significant difference was noted in the proportion of severe hypoglycemia（P = 0.877） among the three stages.Conclusion Glycemic control directed by computer-assistant insulin infusion protocol could achieve better blood glucose level as well as spare the risk of hypoglycemia.

关 键 词：胰岛素 血糖控制方案 危重症监护 

分 类 号：R587[医药卫生—内分泌]