适集思血糖控制在ICU应激性高血糖管理中的价值  

The value of space glucose control in ICU stress hyperglycemia management

作　　者：陆娟[1] 刘鹏程 刘励军[1] 朱建军[1] 周保纯[1] 朱艳[1] 詹静晔 包群英[1] 田晓艳 Lu Juan;Liu Pengcheng;Liu Lijun;Zhu Jianjun;Zhou Baochun;Zhu Yan;Zhan Jingye;Bao Qunying;TianXiaoyan(Department of Emergency,The Second Affiliated Hospital of Soochow University,Suzhou 215000,China)

机构地区：[1]江苏省苏州大学附属第二医院急诊科,215000

出　　处：《中华急诊医学杂志》2019年第11期1395-1399,共5页Chinese Journal of Emergency Medicine

基　　金：江苏省高校自然基金面上项目(17KJB320015);苏州市医学重点学科(Szxk201504);苏州市科技发展项目(应用基础研究-医疗卫生)(SYSD2014098)。

摘　　要：目的探讨适集思血糖控制(space glucose control,SGC)对ICU应激性高血糖患者血糖管理质量的影响。方法采取前瞻性交叉对照的类试验研究方法观察2018年1月至2019年1月期间收住苏州大学附属第二医院综合ICU应激性高血糖的患者。以常规血糖管理作为对照组,SGC方式作为试验组;入选患者每24 h两组间互换,试验终点为96 h。比较两种管理方式对患者血糖管理质量指标的差异,主要包括患者的平均血糖值、血糖最高值和最低值、平均血糖监测间隔时间、累积胰岛素用量。采用SPSS 23.0进行统计分析,正态分布的计量资料采用配对t检验;不符合正态分布的计量资料,采用非参数秩和检验;以P<0.05为差异有统计学意义。结果共有41例患者进入研究,SGC方式的血糖水平明显低于常规方式[(8.60±1.42)mmol/L vs(10.02±1.49)mmol/L,P<0.01],高血糖发生次数低于常规方式(16.59±8.56 vs 18.73±7.91,P=0.023),血糖值在目标血糖值范围内的频次明显高于常规血糖管理方式(53.07±19.11 vs 29.44±19.60,P<0.01)。但SGC方式的低血糖发生频次、血糖监测频次、累积胰岛素用量等均高于常规方式,分别为:[1(0,5)vs 0(0,2),P<0.01]、(1.36±0.23 vs 1.89±0.28,P<0.01)、[(139.61±77.06)U vs(107.49±64.41)U,P<0.01)]。结论SGC血糖管理方式能更优化控制血糖在目标血糖范围,但易导致轻度低血糖的发生,并且在一定程度上增加了医护人员的工作量。Objective To investigate the effect of space glucose control(SGC)on the quality of blood glucose management in ICU patients with stress hyperglycemia.Methods A prospective,cross-controlled,quasi-trial was conducted to observe patients with ICU-induced stress hyperglycemia between January 2018 and January 2019.Patients with conventional blood glucose management served as the control group,and SGC blood glucose management was used as the intervention group.The enrolled patients were interchanged between the two groups every 24 h,and the end point was 96 h.The differences in blood glucose management quality indicators between the two groups were compared,including the average blood glucose level,the highest and lowest blood glucose level,the average blood glucose monitoring interval,and the accumulated insulin dosage.SPSS 23.0 was used to analyze the data.The paired t test was used for the normal distributed data.Otherwise,two nonparametric correlation sample tests was used.A P<0.05 was considered statistically significant.Results A total of 41 patients enrolled in this study during the study period.The average blood glucose value in the intervention group was significantly lower than that in the control group[(8.60±1.42)mmol/L vs(10.02±1.49)mmol/L,P<0.01].The frequency of hyperglycemia was lower than that of the control group(16.59±8.56 vs 18.73±7.91,P=0.023).The frequency of blood glucose value in the target blood glucose range was significantly higher than that of the control group(53.07±19.11 vs 29.44±19.60,P<0.01).However,the frequency of hypoglycemia,the frequency of blood glucose monitoring and the accumulated insulin dosage in the intervention group were higher than those in the control group[1(0,5)vs 0(0,2),P<001;136±023 vs 189±028,P<0.01;and(139.61±77.06)U vs(107.49±64.41)U,P<0.01].Conclusions SGC can optimize the control of blood glucose in the target blood glucose range,but it can easily lead to mild hypoglycemia,and to a certain extent increases the workload of medical staff.

关 键 词：SGC ICU患者 应激性高血糖 血糖管理 

分 类 号：R58[医药卫生—内分泌]