Insulin Diabetes Experimental Research Group, Faculty of Medicine and Health Sciences, The University of Nottingham, Clifton Boulevard, Nottingham NG7 2UH, United Kingdom.
Intensive Crit Care Nurs. 2009 Dec;25(6):294-305. doi: 10.1016/j.iccn.2009.09.002. Epub 2009 Oct 21.
Hyperglycaemia occurs in a substantial proportion of critically ill patients. Recent studies have demonstrated that controlling blood glucose in critically ill patients can improve outcomes (Boord et al., 2001). Traditionally, blood glucose is controlled by the sliding scale method. A pre-defined dose of intravenous insulin is infused for each glucose level. Revisions to the prescription are frequently necessary when it is ineffective. The objective of this review is to assess the effectiveness, safety and feasibility of nurse-managed protocols that require minimal physician input.
An electronic search was performed on the Medline, CINAHL and EMBASE databases from 1996 to 2008. The objective of this work was to assess nurse-managed glycaemic control in critically ill patients. The target blood glucose was required to be less than 8.3mmol/L.
Fourteen papers met the inclusion criteria. Eight studies compared their protocol to the previous method of glucose control (Table 1). In all cases there was an improvement. Time to reach target was less and time spent within target range was greater. All but one study reduced episodes of hypoglycaemia with the new protocol. Six studies developed their protocol as a quality improvement project and did not use a control group (Table 2).
An insulin infusion protocol (IIP) that uses the last two blood glucose levels in order to determine the new infusion rate is better at maintaining glycaemic control than the traditional sliding scale method. A protocol that allows a nurse to commence and maintain the infusion is as safe and more effective than the traditional sliding scale method.
大量危重症患者存在高血糖现象。近期研究表明，危重症患者血糖控制可改善预后（Boord 等，2001）。传统上，通过血糖调整方案控制血糖。对于每个血糖水平，均输注预先设定剂量的静脉胰岛素。当该方案无效时，通常需要频繁调整方案。本综述旨在评估需要医师最少干预的护士管理方案的有效性、安全性和可行性。
对 1996 年至 2008 年 Medline、CINAHL 和 EMBASE 数据库进行电子检索。本研究旨在评估危重症患者的护士管理血糖控制情况。目标血糖需＜8.3mmol/L。
符合纳入标准的论文有 14 篇。8 项研究将其方案与之前的血糖控制方法进行了比较（表 1）。所有研究均显示改善。达到目标的时间更短，目标范围内的时间更长。新方案除 1 项外均减少了低血糖发作。6 项研究将方案作为质量改进项目开发，未使用对照组（表 2）。
与传统的血糖调整方案相比，采用最后两个血糖值来确定新输注率的胰岛素输注方案（IIP）在维持血糖控制方面更有效。允许护士开始和维持输注的方案与传统的血糖调整方案同样安全，但更有效。
