Vriesendorp Titia M, van Santen Susanne, DeVries J Hans, de Jonge Evert, Rosendaal Frits R, Schultz Marcus J, Hoekstra Joost B L
Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands.
Crit Care Med. 2006 Jan;34(1):96-101. doi: 10.1097/01.ccm.0000194536.89694.06.
The introduction of strict glycemic control in the intensive care unit has increased the risk for hypoglycemia. In this study we examined the association between predefined circumstances and the occurrence of hypoglycemia in the intensive care unit.
: Retrospective cohort study.
Academic medical center.
All episodes of hypoglycemia (glucose value <45 mg/dL) in our intensive care unit between September 2002 and September 2004 were identified. Presence of predefined circumstances previously associated with hypoglycemia was scored around the moment of hypoglycemia using a patient data management system and in-hospital charts. Patients with a first hypoglycemic event were contrasted to controls from the same cohort, who were matched for time since admission, to correct for the effect of length of stay. Data were analyzed using conditional logistic regression analysis.
None.
Of 2,272 patients, 156 (6.9%) experienced at least one episode of hypoglycemia. Continuous venovenous hemofiltration with bicarbonate-based substitution fluid (odds ratio [OR], 14; 95% confidence interval [CI], 1.8-106), a decrease of nutrition without adjustment for insulin infusion (OR, 6.6; 95% CI, 1.9-23), diabetes mellitus (OR, 2.6; 95% CI, 1.5-4.7), insulin use (OR, 5.3; 95% CI, 2.8-11), sepsis (OR, 2.2; 95% CI, 1.2-4.1), and inotropic support (OR, 1.8; 95% CI, 1.1-2.9) were associated with hypoglycemia. Simultaneous octreotide and insulin use (OR, 6.0; 95% CI, 0.72-50) may also be associated with hypoglycemia. Gastric residual during enteral nutrition without adjusting insulin infusion, liver failure, continuous venovenous hemofiltration with lactate-based substitution fluid, diminished glomerular filtration rate, dose diminishment of glucocorticoids or catecholamines, and use of beta-blocking agents were not associated with hypoglycemia. Adjusting for age, gender, and Acute Physiology and Chronic Health Evaluation II score at admission did not materially change ORs.
Use of bicarbonate-based substitution fluid during continuous venovenous hemofiltration, a decrease of nutrition without adjustment for insulin infusion, a prior diagnosis of diabetes mellitus, sepsis, and need for inotropic support were found to be associated with hypoglycemia. Simultaneous use of insulin and octreotide may be associated with hypoglycemia.
重症监护病房引入严格血糖控制增加了低血糖风险。在本研究中，我们调查了重症监护病房中预设情况与低血糖发生之间的关联。
回顾性队列研究。
学术医疗中心。
确定了2002年9月至2004年9月期间我们重症监护病房所有低血糖发作（血糖值<45mg/dL）情况。使用患者数据管理系统和住院病历，在低血糖发生时刻对先前与低血糖相关的预设情况进行评分。将首次发生低血糖事件的患者与同一队列中根据入院时间匹配的对照组进行对比，以校正住院时间的影响。使用条件逻辑回归分析对数据进行分析。
无。
2272例患者中，156例（6.9%）至少经历过一次低血糖发作。使用基于碳酸氢盐的置换液进行持续静静脉血液滤过（比值比[OR]，14；95%置信区间[CI]，1.8 - 106）、未调整胰岛素输注情况下营养减少（OR，6.6；95%CI，1.9 - 23）、糖尿病（OR，2.6；95%CI，1.5 - 4.7）、使用胰岛素（OR，5.3；95%CI，2.8 - 11）、脓毒症（OR，2.2；95%CI，1.2 - 4.1）和使用血管活性药物支持（OR，1.8；95%CI，1.1 - 2.9）与低血糖相关。同时使用奥曲肽和胰岛素（OR，6.0；95%CI，0.72 - 50）也可能与低血糖相关。肠内营养期间胃残余量未调整胰岛素输注、肝功能衰竭、使用基于乳酸盐的置换液进行持续静静脉血液滤过、肾小球滤过率降低、糖皮质激素或儿茶酚胺剂量减少以及使用β受体阻滞剂与低血糖无关。校正年龄、性别和入院时急性生理与慢性健康状况评分II后，OR值无实质性变化。
持续静静脉血液滤过期间使用基于碳酸氢盐的置换液、未调整胰岛素输注情况下营养减少、先前诊断为糖尿病、脓毒症以及需要血管活性药物支持与低血糖相关。同时使用胰岛素和奥曲肽可能与低血糖相关。
