Ellmerer Martin, Haluzik Martin, Blaha Jan, Kremen Jaromir, Svacina Stepan, Toller Wolfgang, Mader Julia, Schaupp Lukas, Plank Johannes, Pieber Thomas
Department of Internal Medicine, Medical University Graz, Stiftingtalstrasse 24, A-8010 Graz, Austria.
Diabetes Care. 2006 Jun;29(6):1275-81. doi: 10.2337/dc05-2377.
Tight glycemic control improves outcome in critically ill patients but requires frequent glucose measurements. Subcutaneous adipose tissue (SAT) has been characterized as promising for glucose monitoring in diabetes, but it remains unknown whether it can also be used as an alternative site in critically ill patients. The present study was performed to clinically evaluate the relation of glucose in SAT compared with arterial blood in patients after major cardiac surgery.
Forty critically ill patients were investigated at two clinical centers after major cardiac surgery. Arterial blood and SAT microdialysis samples were taken in hourly intervals for a period of up to 48 h. The glucose concentration in dialysate was calibrated using a two-step approach, first using the ionic reference technique to calculate the SAT glucose concentration (SATg) and second using a one-point calibration procedure to obtain a glucose profile comparable to SAT-derived blood glucose (BgSAT). Clinical validation of the data was performed by introducing data analysis based on an insulin titration algorithm.
Correlation between dialysate glucose and blood glucose (median 0.80 [interquartile range 0.68-0.88]) was significantly improved using the ionic reference calibration technique (SATg vs.blood glucose 0.90 [0.83-0.94]; P < 0.001). Clinical evaluation of the data indicated that 96.1% of glucose readings from SAT would allow acceptable treatment according to a well-established insulin titration protocol.
The results indicate good correlation between SATg and blood glucose in patients after major cardiac surgery. Clinical evaluation of the data suggests that with minor limitations, glucose from SAT can be used to establish tight glycemic control in this patient group.
严格血糖控制可改善危重症患者的预后，但需要频繁测量血糖。皮下脂肪组织（SAT）已被认为有望用于糖尿病患者的血糖监测，但在危重症患者中它是否也能作为替代部位仍不清楚。本研究旨在临床评估心脏大手术后患者SAT中的葡萄糖与动脉血中葡萄糖的关系。
在两个临床中心对40例心脏大手术后的危重症患者进行了研究。每隔1小时采集动脉血和SAT微透析样本，持续48小时。透析液中的葡萄糖浓度采用两步法进行校准，首先使用离子参考技术计算SAT葡萄糖浓度（SATg），其次使用单点校准程序获得与SAT衍生血糖（BgSAT）相当的血糖曲线。通过引入基于胰岛素滴定算法的数据分析对数据进行临床验证。
使用离子参考校准技术后，透析液葡萄糖与血糖之间的相关性（中位数0.80[四分位间距0.68 - 0.88]）显著改善（SATg与血糖的相关性为0.90[0.83 - 0.94]；P < 0.001）。对数据的临床评估表明，根据既定的胰岛素滴定方案，SAT测得的葡萄糖读数中有96.1%可实现可接受的治疗。
结果表明心脏大手术后患者的SATg与血糖之间具有良好的相关性。对数据的临床评估表明，尽管存在一些小的局限性，但SAT中的葡萄糖可用于在该患者群体中建立严格的血糖控制。
