心脏手术患者中采用可变采样率的模型预测控制算法与常规血糖管理方案进行血糖控制的随机对照试验。

Blood glucose control by a model predictive control algorithm with variable sampling rate versus a routine glucose management protocol in cardiac surgery patients: a randomized controlled trial.

作者信息

Hovorka Roman, Kremen Jaromir, Blaha Jan, Matias Michal, Anderlova Katerina, Bosanska Lenka, Roubicek Tomas, Wilinska Malgorzata E, Chassin Ludovic J, Svacina Stepan, Haluzik Martin

机构信息

Department of Pediatrics, University of Cambridge, UK.

出版信息

J Clin Endocrinol Metab. 2007 Aug;92(8):2960-4. doi: 10.1210/jc.2007-0434. Epub 2007 Jun 5.

DOI:10.1210/jc.2007-0434

PMID:17550955

Abstract

CONTEXT

Elevated blood glucose levels occur frequently in the critically ill. Tight glucose control by intensive insulin treatment markedly improves clinical outcome.

OBJECTIVE AND DESIGN

This is a randomized controlled trial comparing blood glucose control by a laptop-based model predictive control algorithm with a variable sampling rate [enhanced model predictive control (eMPC); version 1.04.03] against a routine glucose management protocol (RMP) during the peri- and postoperative periods.

SETTING

The study was performed at the Department of Cardiac Surgery, University Hospital.

PATIENTS

A total of 60 elective cardiac surgery patients were included in the study.

INTERVENTIONS

Elective cardiac surgery and treatment with continuous insulin infusion (eMPC) or continuous insulin infusion combined with iv insulin boluses (RMP) to maintain euglycemia (target range 4.4-6.1 mmol/liter) were performed. There were 30 patients randomized for eMPC and 30 for RMP treatment. Blood glucose was measured in 1- to 4-h intervals as requested by each algorithm during surgery and postoperatively over 24 h.

MAIN OUTCOME MEASURES

Mean blood glucose, percentage of time in target range, and hypoglycemia events were used.

RESULTS

Mean blood glucose was 6.2 +/- 1.1 mmol/liter in the eMPC vs. 7.2 +/- 1.1 mmol/liter in the RMP group (P < 0.05); percentage of time in the target range was 60.4 +/- 22.8% for the eMPC vs. 27.5 +/- 16.2% for the RMP group (P < 0.05). No severe hypoglycemia (blood glucose < 2.9 mmol/liter) occurred during the study. Mean insulin infusion rate was 4.7 +/- 3.3 IU/h in the eMPC vs. 2.6 +/- 1.7 IU/h in the RMP group (P < 0.05). Mean sampling interval was 1.5 +/- 0.3 h in the eMPC vs. 2.1 +/- 0.2 h in the RMP group (P < 0.05).

CONCLUSIONS

Compared with RMP, the eMPC algorithm was more effective and comparably safe in maintaining euglycemia in cardiac surgery patients.

摘要

背景

危重症患者中血糖水平升高的情况频繁出现。强化胰岛素治疗进行严格血糖控制可显著改善临床结局。

目的与设计

这是一项随机对照试验，比较基于笔记本电脑的可变采样率模型预测控制算法[增强型模型预测控制（eMPC）；版本1.04.03]与常规血糖管理方案（RMP）在围手术期和术后控制血糖的效果。

地点

该研究在大学医院心脏外科进行。

患者

共有60例择期心脏手术患者纳入本研究。

干预措施

进行择期心脏手术，并采用持续胰岛素输注（eMPC）或持续胰岛素输注联合静脉推注胰岛素（RMP）以维持血糖正常（目标范围4.4 - 6.1毫摩尔/升）。随机分配30例患者接受eMPC治疗，30例接受RMP治疗。在手术期间及术后24小时内，按照各算法要求每隔1至4小时测量一次血糖。

主要观察指标

采用平均血糖、目标范围内时间百分比及低血糖事件。

结果

eMPC组平均血糖为6.2±1.1毫摩尔/升，RMP组为7.2±1.1毫摩尔/升（P < 0.05）；eMPC组目标范围内时间百分比为60.4±22.8%，RMP组为27.5±16.2%（P < 0.05）。研究期间未发生严重低血糖（血糖<2.9毫摩尔/升）。eMPC组平均胰岛素输注速率为4.7±3.3国际单位/小时，RMP组为2.6±1.7国际单位/小时（P < 0.05）。eMPC组平均采样间隔为1.5±0.3小时，RMP组为2.1±0.2小时（P < 0.05）。