University of Florida College of Medicine, Gainesville, FL 32610-0254, USA.
Anesth Analg. 2010 Apr 1;110(4):1056-65. doi: 10.1213/ANE.0b013e3181cc07de. Epub 2010 Feb 8.
Abnormalities of blood glucose are common in patients undergoing surgery, and in recent years there has been considerable interest in tight control of glucose in the perioperative period. Implementation of any regime of close glycemic control requires more frequent measurement of blood glucose, a function for which small, inexpensive, and rapidly responding point-of-care devices might seem highly suitable. However, what is not well understood by many anesthesiologists and other staff caring for patients in the perioperative period is the lack of accuracy of home glucose meters that were designed for self-monitoring of blood glucose by patients. These devices have been remarketed to hospitals without appropriate additional testing and without an appropriate regulatory framework. Clinicians who are accustomed to the high level of accuracy of glucose measurement by a central laboratory device or by an automated blood gas analyzer may be unaware of the potential for harmful clinical errors that are caused by the inaccuracy exhibited by many self-monitoring of blood glucose devices, especially in the hypoglycemic range. Knowledge of the limitations of these meters is essential for the perioperative physician to minimize the possibility of a harmful measurement error. In this article, we will highlight these areas of interest and review the indications, technology, accuracy, and regulation of glucose measurement devices used in the perioperative setting.
血糖异常在手术患者中很常见，近年来，人们对围手术期血糖的严格控制产生了浓厚的兴趣。实施任何严格血糖控制方案都需要更频繁地测量血糖，而小型、廉价、快速响应的即时检测设备似乎非常适合这一功能。然而，许多麻醉师和其他在围手术期照顾患者的医护人员并不了解，为患者自我监测血糖而设计的家用血糖仪缺乏准确性。这些设备未经适当的额外测试和适当的监管框架就重新推向了医院。习惯于中心实验室设备或自动血气分析仪进行的葡萄糖测量具有高精度的临床医生可能没有意识到，许多自我监测血糖设备所表现出的不准确性可能导致有害的临床错误，尤其是在低血糖范围内。围手术期医生必须了解这些血糖仪的局限性，以最大程度地减少有害测量误差的可能性。在本文中，我们将重点介绍这些感兴趣的领域，并回顾围手术期使用的葡萄糖测量设备的适应证、技术、准确性和监管情况。
