Holzinger Ulrike, Feldbacher Monika, Bachlechner Adelbert, Kitzberger Reinhard, Fuhrmann Valentin, Madl Christian
Intensive Care Unit, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria.
Am J Crit Care. 2008 Mar;17(2):150-6.
Strict glycemic control in critically ill patients is challenging for both physicians and nurses.
To determine the effect of focused education of intensive care staff followed by implementation of a glucose control protocol.
A prospective observational study in a medical intensive care unit in a university hospital. After intensive education of nurses and physicians, a glucose control protocol with a nurse-managed insulin therapy algorithm was developed and implemented. Every measured blood glucose value and insulin dose per hour and per day were documented in 36 patients before and 44 patients after implementation of the protocol.
Median blood glucose levels decreased after implementation of the protocol (133 vs 110 mg/dL; P < .001). The amounts of time when patients' blood glucose levels were less than 110 mg/dL and less than 150 mg/dL increased after implementation of the protocol (8% vs 44%; 75% vs 96%; P<.001). The median use of insulin increased after implementation of the protocol (28 vs 35 IU/day; P=.002). Diabetic patients had higher median blood glucose levels than did nondiabetic patients both before (138 vs 131 mg/dL) and after (115 vs 108 mg/dL; P<.001) implementation, although median insulin use also increased (before implementation, 33 vs 26 IU/day; P=.04; after implementation, 46 vs 30 IU/day; P < .001).
Use of a collaboratively developed glucose control protocol led to decreased median blood glucose levels and to longer periods of normoglycemia. Despite increased insulin use, glucose control was worse in diabetic patients.
对重症患者进行严格的血糖控制对医生和护士来说都具有挑战性。
确定对重症监护人员进行重点教育并随后实施血糖控制方案的效果。
在一家大学医院的内科重症监护病房进行一项前瞻性观察研究。在对护士和医生进行强化教育后，制定并实施了一项由护士管理胰岛素治疗算法的血糖控制方案。在方案实施前，记录了36例患者每小时和每天的每次测量血糖值及胰岛素剂量；方案实施后，记录了44例患者的相关数据。
方案实施后，血糖中位数水平下降（133 vs 110 mg/dL；P <.001）。方案实施后，患者血糖水平低于110 mg/dL和低于150 mg/dL的时间增加（8% vs 44%；75% vs 96%；P<.001）。方案实施后，胰岛素的使用中位数增加（28 vs 35 IU/天；P=.002）。糖尿病患者在方案实施前（138 vs 131 mg/dL）和实施后（115 vs 108 mg/dL；P<.001）的血糖中位数水平均高于非糖尿病患者，尽管胰岛素使用中位数也有所增加（实施前，33 vs 26 IU/天；P=.04；实施后，46 vs 30 IU/天；P <.001）。
使用共同制定的血糖控制方案可降低血糖中位数水平，并延长血糖正常的时间。尽管胰岛素使用增加，但糖尿病患者的血糖控制情况更差。
