护士主导在医疗重症监护病房实施安全有效的静脉胰岛素方案。

Nurse-led implementation of a safe and effective intravenous insulin protocol in a medical intensive care unit.

作者信息

Khalaila Rabia, Libersky Eugene, Catz Dina, Pomerantsev Elina, Bayya Abed, Linton David M, Sviri Sigal

机构信息

Medical ICU, Hadassah–Hebrew University Medical Center, P. O. Box 91120, Jerusalem, Israel.

出版信息

Crit Care Nurse. 2011 Dec;31(6):27-35. doi: 10.4037/ccn2011934.

DOI:10.4037/ccn2011934

PMID:22135329

Abstract

BACKGROUND

Recent evidence has linked tight glucose control to worsened clinical outcomes among adults in intensive care units.

OBJECTIVE

To evaluate the effectiveness and safety of a nurse-led intravenous insulin protocol designed to achieve conservative blood glucose control in patients in a medical intensive care unit.

METHODS

A nurse-led intravenous insulin protocol was developed, targeting blood glucose levels at 110 to 149 mg/dL. Hypoglycemia was defined as a blood glucose level less than 70 mg/dL. Patients admitted to the medical intensive care unit who required an insulin infusion were enrolled in the study. Blood glucose levels in those patients were compared with levels in 153 historical control patients admitted to the unit in the 12 months before the protocol was implemented who required an insulin infusion.

RESULTS

Ninety-six patients were enrolled and treated with the protocol. The protocol and control groups had similar characteristics at baseline. More measurements in the protocol group than in the control group (46.3% vs 36.1%, P<.001) were within the target glucose range (110-149 mg/dL). Hyperglycemia (blood glucose ≥200 mg/dL) occurred less often in the protocol group than in the control group (14.8% vs 20.1%, P=.003). Hypoglycemic events (blood glucose <70 mg/dL) also occurred less often in the protocol group (0.07% vs 0.83%, P<.001).

CONCLUSIONS

Implementation of a nurse-led, conservative intravenous insulin protocol in the medical intensive care unit is effective and safe and markedly reduces the rate of hypoglycemia.

摘要

背景

近期证据表明，重症监护病房的成人患者严格控制血糖会导致临床结局恶化。

目的

评估由护士主导的静脉胰岛素方案在医疗重症监护病房患者中实现保守血糖控制的有效性和安全性。

方法

制定了由护士主导的静脉胰岛素方案，将血糖目标水平设定为110至149mg/dL。低血糖定义为血糖水平低于70mg/dL。纳入需要静脉输注胰岛素的医疗重症监护病房患者进行研究。将这些患者的血糖水平与在该方案实施前12个月入住该病房且需要静脉输注胰岛素的153例历史对照患者的血糖水平进行比较。

结果

96例患者纳入并采用该方案治疗。方案组和对照组在基线时具有相似特征。方案组血糖在目标范围内（110 - 149mg/dL）的测量次数多于对照组（46.3%对36.1%，P<0.001）。方案组高血糖（血糖≥200mg/dL）发生率低于对照组（14.8%对20.1%，P = 0.003）。方案组低血糖事件（血糖<70mg/dL）发生率也较低（0.07%对0.83%，P<0.001）。