ICU患者胰岛素静脉输注管理的最佳证据应用  

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

作　　者：许华娇 吴玲玲 杨云 张杰 张琦 Xu Huajiao;Wu Lingling;Yang Yun;Zhang Jie;Zhang Qi(Nursing Department,Jinshan Hospital of Fudan University,Shanghai 201508,China)

机构地区：[1]复旦大学附属金山医院护理部,上海201508 [2]复旦大学附属金山医院ICU,上海201508 [3]复旦大学附属中山医院护理部

出　　处：《护理学杂志》2024年第21期11-15,共5页Journal of Nursing Science

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)。

摘　　要：目的将ICU患者胰岛素静脉输注管理的最佳证据应用于临床实践,评价其应用效果。方法以证据临床转化模式为指导,将总结的最佳证据转化为12条质量审查指标并进行基线审查,分析促进与障碍因素,实施变革。比较证据应用前后审查指标执行率,医护人员胰岛素静脉输注管理知识得分,患者的平均血糖值、高血糖发生率、低血糖发生率及血糖变异系数。结果最佳证据应用后,10条证据应用的执行率显著高于基线审查水平,医护人员胰岛素静脉输注管理知识得分由(47.87±14.76)分提升至(88.32±9.56)分(均P<0.05)。证据应用后患者高血糖发生率、平均血糖值及高血糖变异性发生率显著低于应用前(均P<0.05)。结论将ICU患者胰岛素静脉输注管理的最佳证据应用于临床,能有效优化医护人员对ICU患者胰岛素静脉输注管理知识水平及实践行为,促进患者血糖稳定。Objective To translate the best evidence regarding intravenous insulin therapy for ICU patients into practice,and to eva-luate its effectiveness.Methods Guided by the evidence implementation model,the best evidence summarized was translated into 12 audit indicators and baseline audit was conducted,then barriers and facilitators were identified,and reform was made.The execution rate of audit indicators and knowledge of medical staff toward intravenous insulin infusion were compared before and after evidence implementation.Meanwhile,blood glucose level,incidence of hyperglycemia and hypoglycemia,as well as percentage coefficient of variation for glucose(%CV)in patients were also compared.Results After implementing the best evidence,the execution rates of 10 audit indicators were significantly enhanced(all P<0.05).The total score of knowledge of medical staff was also improved from(47.87±14.76)points to(88.32±9.56)points,with a statistically significant difference(P<0.05).Patients′blood glucose level,the incidence of hyperglycemia,and proportion of high%CV were significantly reduced after evidence implementation(all P<0.05).Conclusion Integrating the best evidence into clinical practice for intravenous insulin infusion in ICU patients,can improve medical staff′s knowledge and behavior of intravenous insulin therapy,which result in stabilizing patients′blood glucose.

关 键 词：危重症 ICU 微量泵 胰岛素输注 血糖管理 最佳证据 循证实践 

分 类 号：R472.2[医药卫生—急诊医学]