荷兰危重症成年患者血糖控制情况调查。

Survey into blood glucose control in critically ill adult patients in the Netherlands.

作者信息

Schultz M J, Binnekade J M, Harmsen R E, de Graaff M J, Korevaar J C, van Braam Houckgeest F, van der Sluijs J P, Kieft H, Spronk P E

机构信息

Department of Intensive Care, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.

出版信息

Neth J Med. 2010 Feb;68(2):77-83.

PMID:20167959

Abstract

BACKGROUND

To study current clinical practice in blood glucose (BG) control in adult intensive care units (ICUs) in the Netherlands.

METHODS

We performed a national survey focusing on blood glucose targets, insulin administration, BG control guidelines, and opinions regarding BG control aiming for normoglycaemia (known as intensive insulin therapy, IIT).

RESULTS

The completed questionnaire was returned by 88/113 (78%) of the participating centres. In 98% (86/88) of the ICUs some sort of BG control was being practised. Half of the ICUs (42/86, 48%) used tight BG targets as with IIT; 28/86 (33%) and 13/86 (15%) used more liberal targets of 4.4 to 7.0 mmol/l and 4.4 to 8.0 mmol/l, respectively. Eighty-two (93%) reported having a local guideline on BG control (or IIT). The BG threshold to start insulin was 7.0+/-1.3 mmol/l vs 7.8+/-1.3 mmol/l in ICUs that practised IIT vs ICUs that practised less tight BG control, respectively (p=0.005). In 28/86 (33%) measurement of the BG values was done according to a strict time schedule (i.e., BG values were measured on predefined time points). While respondents were fairly agreed on the benefits of IIT, opinions regarding ease of implementation and time needed to apply this strategy varied. In addition, severe hypoglycaemia was considered a serious side effect of IIT.

CONCLUSION

Approximately half of the ICUs in the Netherlands reported having implemented IIT. However, the full guideline as used in the original studies on IIT was hardly ever implemented. Concerns about severe hypoglycaemia, at least in part, hampers implementation of IIT.

摘要

背景

研究荷兰成人重症监护病房（ICU）血糖（BG）控制的当前临床实践。

方法

我们进行了一项全国性调查，重点关注血糖目标、胰岛素给药、BG控制指南以及关于实现正常血糖（即强化胰岛素治疗，IIT）的BG控制的意见。

结果

113个参与中心中的88个（78%）返回了完整问卷。98%（86/88）的ICU正在进行某种形式的BG控制。一半的ICU（42/86，48%）使用与IIT相同的严格BG目标；28/86（33%）和13/86（15%）分别使用更宽松的目标，即4.4至7.0 mmol/l和4.4至8.0 mmol/l。82个（93%）报告有关于BG控制（或IIT）的当地指南。与实施不太严格BG控制的ICU相比，实施IIT的ICU开始胰岛素治疗的BG阈值分别为7.0±1.3 mmol/l和7.8±1.3 mmol/l（p = 0.005）。28/86（33%）根据严格的时间表测量BG值（即，在预定义的时间点测量BG值）。虽然受访者对IIT的益处相当认同，但关于该策略实施的难易程度和所需时间的意见各不相同。此外，严重低血糖被认为是IIT的严重副作用。