EA 3920, INSERM IFR 133, Department of Anaesthesiology and Intensive Care Medicine, Jean Minjoz Hospital, University of Franche-Comté, 3 Blvd. Fleming, Besançon, France.
Diabetes Metab. 2010 Feb;36(1):71-8. doi: 10.1016/j.diabet.2009.05.008. Epub 2010 Jan 25.
Perioperative tight blood glucose (BG) control using insulin therapy after major surgery is a difficult, time-consuming task that also raises some concerns over the risk of severe hypoglycaemia. The aim of the present prospective study was to evaluate the efficacy and safety of an insulin therapy protocol in use at our institution.
A total of 230 consecutive patients (mean+/-SD age: 67+/-11 years; diabetic patients: n=62) undergoing cardiac surgery (coronary artery bypass grafting: n=137; 20% off-pump) or intrathoracic aortic (n=10) surgery were included. BG control was managed according to an insulin therapy protocol, described by Goldberg et al. (2004) [11], in use for 6 months in our intensive care unit. Insulin infusion rate and frequency of BG monitoring were both adjusted according to: (1) the current BG value; (2) the previous BG value; and (3) the current insulin infusion rate. Efficacy was assessed by the percentage of time spent at the target BG level (100-139 mg/dL) intraoperatively and during the first 2 postoperative days (POD).
All patients received postoperative insulin therapy. Patients spent 57.3% and 69.7% of time within the BG target range on POD 1 and 2, respectively. The percentage of time was significantly higher in nondiabetics than in diabetics. Mean BG measurements per patient intraoperatively, on POD 1 and on POD 2 were 4+/-1, 10+/-2 and 7+/-2, respectively. No patient experienced any severe hypoglycaemic events (BG<50mg/dL).
This study showed that a BG target of 100-139 mg/dL can be safely achieved with an insulin therapy protocol that can be routinely used in everyday clinical practice.
在大手术后使用胰岛素治疗进行围手术期严格血糖（BG）控制是一项困难且耗时的任务，同时也引起了对严重低血糖风险的一些担忧。本前瞻性研究的目的是评估我们机构使用的胰岛素治疗方案的疗效和安全性。
共纳入 230 例连续接受心脏手术（冠状动脉旁路移植术：n=137；20%非体外循环）或胸内主动脉手术（n=10）的患者（平均+/-标准差年龄：67+/-11 岁；糖尿病患者：n=62）。根据 Goldberg 等人（2004 年）[11]描述的胰岛素治疗方案来管理 BG 控制，该方案已在我们的重症监护病房使用了 6 个月。根据以下三个因素调整胰岛素输注率和 BG 监测频率：（1）当前 BG 值；（2）先前的 BG 值；（3）当前胰岛素输注率。术中及术后第 1 和第 2 天（POD）目标 BG 水平的时间百分比评估疗效。
所有患者均接受术后胰岛素治疗。患者在 POD1 和 POD2 期间分别有 57.3%和 69.7%的时间处于 BG 目标范围内。非糖尿病患者的时间百分比明显高于糖尿病患者。术中、POD1 和 POD2 每位患者的平均 BG 测量值分别为 4+/-1、10+/-2 和 7+/-2。没有患者发生任何严重低血糖事件（BG<50mg/dL）。
本研究表明，使用可常规用于日常临床实践的胰岛素治疗方案，可安全达到 100-139mg/dL 的 BG 目标。
