ICU患者胰岛素静脉输注管理的最佳证据总结  

Summary of best evidence for the management of insulin intravenous infusion in ICU patients

作　　者：许华娇 吴玲玲 张琦 XU Huajiao;WU Lingling;ZHANG Qi

机构地区：[1]复旦大学附属金山医院护理部,上海市201508 [2]复旦大学附属中山医院护理部

出　　处：《中华护理杂志》2023年第12期1489-1495,共7页Chinese Journal of Nursing

基　　金：上海市循证护理中心;复旦大学JBI循证护理合作中心证据转化与临床应用项目(Fudanebn202231);上海市中西医结合学会科研项目(2021-60)。

摘　　要：目的系统检索、评价并综合ICU患者胰岛素静脉输注管理的最佳证据,为临床护理实践提供参考。方法计算机检索BMJ最佳临床实践、国际指南协作网、英国国家卫生与临床优化研究所指南网、美国国立指南网、加拿大安大略注册护士协会指南网、苏格兰院际指南网、澳大利亚乔安娜布里格斯研究所循证卫生保健中心图书馆、Cochrane Library、PubMed、Embase、CINAHL、UpToDate、中国生物医学文献数据库、中国知网、万方数据库及临床指南应用程序中关于ICU患者胰岛素静脉输注管理的最佳临床实践、指南、临床决策、系统评价、证据总结、专家共识。检索时限为建库至2022年8月31日。由2名研究人员独立进行文献筛选和质量评价,根据主题对证据进行提取、总结。结果最终纳入8篇文献,包括2篇指南、1篇系统评价、4篇证据总结、1篇专家共识,形成血糖控制目标、血糖监测技术、胰岛素输注方案、低血糖处置4个主题,共19条最佳证据。结论该研究总结了ICU患者静脉输注胰岛素时血糖监测、胰岛素输注及低血糖处置等最佳证据,为临床护理实践提供了依据。护理人员可结合临床实际情境个性化地进行证据应用,促进ICU静脉胰岛素输注患者的科学管理。Objective To search,evaluate,and synthesize the relevant evidence for the management of insulin intravenous infusion in ICU patients and summarize the best evidence.Methods We searched Guidelines International Network(GIN),National Institute for Health and Care Excellence(NICE),National Guideline Clearinghouse(NGC),Registered Nurse Association of Ontario(RNAO),Scottish Intercollegiate Guidelines Network(SIGN),BMJ Best Practice,JBI,Cochrane Library,PubMed,Embase,CINAHL,UpToDate,SinoMed,CNKI,Wangfang Database and clinical guidelines APP to collect clinical decisions,guidelines,evidence summaries,expert consensuses related to insulin intravenous infusion management of adult patients in ICU.Through literature quality evaluation,the evidence was extracted from the literature that met the quality standards.The search period is from the inception to August 31,2022.Literature screening and quality evaluation were conducted independently by 2 researchers,and the evidence was extracted and summarized according to the subject.Results A total of 8 articles were selected,including 2 guidelines,1 systematic review,4 evidence summaries and 1 expert consensus.Finally,19 pieces of best evidence were formed in 4 aspects,including blood glucose control target,blood glucose monitoring,insulin infusion and hypoglycemia disposal.Conclusion The study summarizes the best evidence for blood glucose monitoring,insulin infusion,and hypoglycemia management during intravenous insulin infusion in critically ill patients,which provides a basis for clinical nursing practice.Nursing staff can reasonably select the best evidence for localization application according to clinical situation to promote the management of ICU patients with intravenous insulin infusion.

关 键 词：胰岛素输注 危重症 重症监护病房 血糖管理 高血糖 低血糖 证据总结 循证护理学 

分 类 号：R473.5[医药卫生—护理学]