Orford N, Stow P, Green D, Corke C
Intensive Care Unit, The Geelong Hospital, Geelong, Victoria.
Crit Care Resusc. 2004 Jun;6(2):92-8.
Recent data have shown a link between normal blood glucose levels and improved outcomes in intensive care patients. We wished to develop an insulin adjustment protocol for an adult intensive care unit to maintain blood glucose concentrations safely within a narrow range.
After a 6 month introductory period, an observational study was conducted during a 10 month period in an Australian level III intensive care unit to assess the safety and feasibility of an insulin adjustment protocol to maintain blood glucose concentrations safely within a narrow range. The protocol included a variable insulin infusion, a constant caloric source and frequent blood glucose level monitoring to detect and prevent hypoglycaemia.
Over the 10 month period a total of 148 patients were studied using the protocol and represented 13 % of all intensive care unit admissions during this period. In total, there were 12,623 patient hours 'on protocol', with 5,603 blood glucose levels performed. The mean morning blood glucose level was 6.5 mmol/L and 49% of blood glucose levels were within the target range of 4.1 - 7.0 mmol/L. There were four recorded incidents of hypoglycaemia, defined as a blood glucose level of less than 2.2 mmol/L, the lowest at 1.5 mmol/L being the only symptomatic episode. The incidence of hyperglycaemia (blood glucose level > 10 mmol/L) was 13 % of all blood glucose level measurements.
The insulin adjustment protocol with a constant caloric source and frequent blood glucose level monitoring was found to be safe and feasible in maintaining blood glucose concentrations within a narrow range in a mixed adult intensive care unit population.
近期数据显示，正常血糖水平与重症监护患者预后改善之间存在关联。我们希望为成人重症监护病房制定一种胰岛素调整方案，以将血糖浓度安全维持在较窄范围内。
在为期6个月的引入期后，于澳大利亚一家三级重症监护病房进行了为期10个月的观察性研究，以评估一种胰岛素调整方案在将血糖浓度安全维持在较窄范围内的安全性和可行性。该方案包括可变胰岛素输注、恒定热量来源以及频繁监测血糖水平以检测和预防低血糖。
在这10个月期间，共对148例患者使用该方案进行了研究，占该期间所有重症监护病房入院患者的13%。总共有12623个患者小时按照方案进行，进行了5603次血糖水平检测。早晨平均血糖水平为6.5 mmol/L，49%的血糖水平在4.1 - 7.0 mmol/L的目标范围内。记录到4次低血糖事件，定义为血糖水平低于2.2 mmol/L，最低为1.5 mmol/L，这是唯一有症状的发作。高血糖（血糖水平>10 mmol/L）的发生率占所有血糖水平测量的13%。
在混合的成人重症监护病房人群中，发现采用恒定热量来源和频繁监测血糖水平的胰岛素调整方案在将血糖浓度维持在较窄范围内是安全可行的。
