体外血糖水平变化很少改变血糖控制算法推荐。

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

Minerva Anestesiol. 2010 Dec;76(12):1018-23. Epub 2010 Jun 28.

BACKGROUND

Hyperglycemia and glycemic variabilities are associated with adverse outcomes in critically ill patients. Blood glucose control with insulin mandates an adequate and precise assessment of blood glucose levels. Blood glucose levels, however, can change ex vivo after sampling. The aim of this study was to determine whether this phenomenon affects the practice of blood glucose control.

METHODS

We performed an observational study in a mixed medical-surgical intensive care unit (ICU). ICU nurses were the primary healthcare workers involved in the practice of blood glucose control, and they used an insulin-titration method and blood-sampling algorithm aimed at maintaining blood glucose levels between 5 to 8 mmol/L.

RESULTS

Blood glucose levels were measured directly after sampling, as well as after 30 and 60 minutes using the same samples. Blood glucose control algorithm recommendations were scored for each measurement. We collected 450 blood samples from 74 patients (median of 3 [2-8] samples per patient). The mean ex vivo changes in the blood glucose level were rather small (-0.1±1.6 mmol/L (range -1.4 to 0.7) and -0.2±1.6 mmol/L (range -1.3 to 0.5) at 30 and 60 minutes after sampling, respectively; P<0.05). An ex-vivo change in the blood glucose level hardly ever resulted in a change in algorithm recommendation (4% and 6% at 30 and 60 minutes after sampling, respectively). In most cases the algorithm advised a lower insulin infusion speed.

CONCLUSION

Ex vivo changes in blood glucose levels, although statistically significant, seem clinically irrelevant.

背景

高血糖和血糖变异性与危重症患者的不良结局相关。胰岛素控制血糖需要对血糖水平进行充分和精确的评估。然而，血糖水平在采样后会在体外发生变化。本研究旨在确定这种现象是否会影响血糖控制实践。

方法

我们在混合内科-外科重症监护病房（ICU）进行了一项观察性研究。ICU 护士是参与血糖控制实践的主要医护人员，他们使用胰岛素滴定方法和采血算法，旨在将血糖水平维持在 5 至 8mmol/L 之间。

结果

直接在采样后测量血糖水平，并在 30 分钟和 60 分钟后使用相同的样本测量。对每次测量的血糖控制算法建议进行评分。我们从 74 名患者中收集了 450 份血样（每位患者中位数为 3[2-8]份血样）。体外血糖水平的平均变化很小（分别为 -0.1±1.6mmol/L（范围 -1.4 至 0.7）和 -0.2±1.6mmol/L（范围 -1.3 至 0.5）在采样后 30 分钟和 60 分钟时；P<0.05）。体外血糖水平的变化几乎从未导致算法建议的改变（分别为 30 分钟和 60 分钟后 4%和 6%）。在大多数情况下，算法建议降低胰岛素输注速度。