Blaha Jan, Kopecky Petr, Matias Michal, Hovorka Roman, Kunstyr Jan, Kotulak Tomas, Lips Michal, Rubes David, Stritesky Martin, Lindner Jaroslav, Semrad Michal, Haluzik Martin
Department of Anaesthesia, Resuscitation and Intensive Medicine, Charles University in Prague, 1st Faculty of Medicine and General University Hospital, Prague, Czech Republic.
Diabetes Care. 2009 May;32(5):757-61. doi: 10.2337/dc08-1851. Epub 2009 Feb 5.
We performed a randomized trial to compare three insulin-titration protocols for tight glycemic control (TGC) in a surgical intensive care unit: an absolute glucose (Matias) protocol, a relative glucose change (Bath) protocol, and an enhanced model predictive control (eMPC) algorithm.
A total of 120 consecutive patients after cardiac surgery were randomly assigned to the three protocols with a target glycemia range from 4.4 to 6.1 mmol/l. Intravenous insulin was administered continuously or in combination with insulin boluses (Matias protocol). Blood glucose was measured in 1- to 4-h intervals as requested by the protocols.
The eMPC algorithm gave the best performance as assessed by time to target (8.8 +/- 2.2 vs. 10.9 +/- 1.0 vs. 12.3 +/- 1.9 h; eMPC vs. Matias vs. Bath, respectively; P < 0.05), average blood glucose after reaching the target (5.2 +/- 0.1 vs. 6.2 +/- 0.1 vs. 5.8 +/- 0.1 mmol/l; P < 0.01), time in target (62.8 +/- 4.4 vs. 48.4 +/- 3.28 vs. 55.5 +/- 3.2%; P < 0.05), time in hyperglycemia >8.3 mmol/l (1.3 +/- 1.2 vs. 12.8 +/- 2.2 vs. 6.5 +/- 2.0%; P < 0.05), and sampling interval (2.3 +/- 0.1 vs. 2.1 +/- 0.1 vs. 1.8 +/- 0.1 h; P < 0.05). However, time in hypoglycemia risk range (2.9-4.3 mmol/l) in the eMPC group was the longest (22.2 +/- 1.9 vs. 10.9 +/- 1.5 vs. 13.1 +/- 1.6; P < 0.05). No severe hypoglycemic episode (<2.3 mmol/l) occurred in the eMPC group compared with one in the Matias group and two in the Bath group.
The eMPC algorithm provided the best TGC without increasing the risk of severe hypoglycemia while requiring the fewest glucose measurements. Overall, all protocols were safe and effective in the maintenance of TGC in cardiac surgery patients.
我们进行了一项随机试验，以比较外科重症监护病房中三种用于严格血糖控制（TGC）的胰岛素滴定方案：绝对血糖（马蒂亚斯）方案、相对血糖变化（巴斯）方案和增强型模型预测控制（eMPC）算法。
总共120例心脏手术后的连续患者被随机分配到三种方案中，目标血糖范围为4.4至6.1 mmol/L。持续静脉注射胰岛素或与胰岛素推注联合使用（马蒂亚斯方案）。按照方案要求每隔1至4小时测量一次血糖。
通过达到目标所需时间（分别为8.8±2.2小时、10.9±1.0小时和12.3±1.9小时；eMPC组、马蒂亚斯组和巴斯组；P<0.05）、达到目标后的平均血糖（分别为5.2±0.1 mmol/L、6.2±0.1 mmol/L和5.8±0.1 mmol/L；P<0.01）、处于目标范围内的时间（分别为62.8±4.4%、48.4±3.28%和55.5±3.2%；P<0.05）、血糖>8.3 mmol/L的高血糖时间（分别为1.3±1.2%、12.8±2.2%和6.5±2.0%；P<0.05）以及采样间隔（分别为2.3±0.1小时、2.1±0.1小时和1.8±0.1小时；P<0.05）评估，eMPC算法表现最佳。然而，eMPC组处于低血糖风险范围（2.9 - 4.3 mmol/L）的时间最长（分别为22.2±1.9、10.9±1.5和13.1±1.6；P<0.05）。与马蒂亚斯组发生1次、巴斯组发生2次严重低血糖事件（<2.3 mmol/L）相比，eMPC组未发生严重低血糖事件。
eMPC算法在不增加严重低血糖风险的情况下提供了最佳的TGC，同时所需的血糖测量次数最少。总体而言，所有方案在维持心脏手术患者的TGC方面都是安全有效的。
