Dickerson Roland N, Swiggart Cortney E, Morgan Laurie M, Maish George O, Croce Martin A, Minard Gayle, Brown Rex O
Department of Clinical Pharmacy, University of Tennessee Health Science Center, Memphis, TN, USA.
Nutrition. 2008 Jun;24(6):536-45. doi: 10.1016/j.nut.2008.02.008. Epub 2008 Apr 10.
The intent of this study was to evaluate the safety and efficacy of our protocol for providing continuous intravenous regular human insulin (RHI) infusion to hyperglycemic critically ill trauma patients receiving specialized nutritional support.
Capillary blood glucose (BG) concentrations were determined every 1-2 h. Glucose control was defined as a BG concentration in the target range of 70-149 mg/dL (3.9-8.3 mmol/L). Data were recorded for 1 d before the RHI infusion and for a maximum of 8 d thereafter while receiving the RHI infusion.
Forty adult critically ill trauma patients received 102 +/- 62 units of RHI daily for 10 +/- 6 d. BG control was achieved within 5 +/- 3 h. BG decreased from 194 +/- 55 mg/dL (10.8 +/- 3.1 mmol/L) to 134 +/- 19 mg/dL (7.4 +/- 1.1 mmol/L) after 1 d of RHI infusion (P < 0.001). Average daily BG ranged from 119 to 124 mg/dL and the target range was maintained for 19.6 +/- 4.7 h/d. None of the patients experienced severe hypoglycemia (<40 mg/dL); 14 patients had asymptomatic hypoglycemia (<60 mg/dL or <3.3 mmol/L) for a total of 23 episodes out of 4140 measurements (0.56%). Estimated creatinine clearance for those with hypoglycemia was 69 +/- 32 mL/min compared with 117 +/- 58 mL/min for the others (P < 0.01).
Our protocol was safe and effective for the management of hyperglycemia in critically ill trauma patients receiving specialized nutritional support but should be used with caution in patients with renal insufficiency.
本研究旨在评估我们为接受特殊营养支持的高血糖重症创伤患者提供持续静脉输注正规人胰岛素（RHI）方案的安全性和有效性。
每1 - 2小时测定一次毛细血管血糖（BG）浓度。血糖控制定义为BG浓度在70 - 149 mg/dL（3.9 - 8.3 mmol/L）的目标范围内。在输注RHI前1天记录数据，并在输注RHI期间最多记录8天的数据。
40例成年重症创伤患者每天接受102±62单位的RHI，持续10±6天。在5±3小时内实现了BG控制。输注RHI 1天后，BG从194±55 mg/dL（10.8±3.1 mmol/L）降至134±19 mg/dL（7.4±1.1 mmol/L）（P < 0.001）。平均每日BG范围为119至124 mg/dL，目标范围维持19.6±4.7小时/天。没有患者发生严重低血糖（<40 mg/dL）；14例患者出现无症状低血糖（<60 mg/dL或<3.3 mmol/L），在4140次测量中共发生23次（0.56%）。低血糖患者的估计肌酐清除率为69±32 mL/min，而其他患者为117±58 mL/min（P < 0.01）。
我们的方案对于接受特殊营养支持的重症创伤患者的高血糖管理是安全有效的，但对于肾功能不全患者应谨慎使用。
