Department of Intensive Care Medicine, Rudolf Magnus Institute of Neuroscience, University Medical Center, Utrecht, The Netherlands.
J Neurosurg Anesthesiol. 2011 Jul;23(3):206-14. doi: 10.1097/ANA.0b013e31821aa6f2.
Intensive insulin therapy protocols are widely used in intensive care medicine. A disadvantage of these protocols may be the occurrence of hypoglycemic episodes. Neurocritical care patients are particularly vulnerable to the effects of hypoglycemia. We aimed to study the risk of hypoglycemia in neurocritical care patients in relation to intensive insulin therapy.
To determine the effects of 2 different intensive insulin therapy protocols on glucose levels and hypoglycemia incidence, we collected data before and after implementation of the protocols in 2 university hospitals. The risk of hypoglycemia (blood glucose level below 3.0 mmol/L) was studied retrospectively with logistic regression analyses.
In hospital A, data were obtained on 152 patients before implementation of the protocol and on 649 patients after implementation of the protocol. In hospital B, data were obtained on 111 patients before implementation of the protocol and on 118 patients thereafter. Implementation of intensive insulin therapy protocols increased the time spent in the desired blood glucose range of 4.6 to 6.0 mmol/L in both hospitals, but increased the risk of hypoglycemia: the absolute risk of hypoglycemia during intensive care unit admission increased in hospital A from 14.5% to 20.3% (adjusted odds ratio=1.3; 95% confidence interval: 0.8-2.3) and in hospital B from 3.6% to 29.7% (adjusted odds ratio=28.6; 95% confidence interval: 5.9-138.9).
Implementation of intensive insulin therapy protocols in neurocritical care patients not only seems to increase the time spent in the desired blood glucose range, but also seems to increase the risk of hypoglycemia. The risk of hypoglycemia strongly depends on characteristics of the intensive insulin therapy protocol.
强化胰岛素治疗方案在重症监护医学中被广泛应用。这些方案的一个缺点可能是低血糖发作的发生。神经重症监护患者尤其容易受到低血糖的影响。我们旨在研究与强化胰岛素治疗相关的神经重症监护患者发生低血糖的风险。
为了确定 2 种不同的强化胰岛素治疗方案对血糖水平和低血糖发生率的影响，我们在 2 所大学医院实施方案前后收集了数据。使用逻辑回归分析回顾性研究低血糖（血糖水平<3.0mmol/L）的风险。
在医院 A，方案实施前获得了 152 例患者的数据，实施后获得了 649 例患者的数据。在医院 B，方案实施前获得了 111 例患者的数据，实施后获得了 118 例患者的数据。在这两家医院，强化胰岛素治疗方案的实施增加了目标血糖范围（4.6-6.0mmol/L）的时间，但增加了低血糖的风险：医院 A 重症监护病房入住期间低血糖的绝对风险从 14.5%增加到 20.3%（调整后的优势比=1.3；95%置信区间：0.8-2.3），医院 B 从 3.6%增加到 29.7%（调整后的优势比=28.6；95%置信区间：5.9-138.9）。
在神经重症监护患者中实施强化胰岛素治疗方案不仅似乎增加了目标血糖范围内的时间，而且似乎增加了低血糖的风险。低血糖的风险强烈取决于强化胰岛素治疗方案的特征。
