Liu Yang, He Wei, Zhou Hua, Li Tong, Xu Yuan
Intensive Care Unit, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China.
Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2012 Sep;24(9):546-9.
To investigate an effective and safe protocol for enteral nutrition (EN) patients permitting successfully transmit insulin administration from venous pump-in to subcutaneous injection.
A prospective randomized control study was conducted. Critical patients admitted to intensive care unit (ICU) of Beijing Tongren Hospital from September 2008 to February 2009 were randomly divided into two groups when the energy provided by EN up to half of the total energy requirement. Experiment group (n=44): the protocol was applied for insulin glargine and regular insulin injection; control group (n=43): protocol was applied for subcutaneous regular insulin injection. Target glucose range was 4.4-7.8 mmol/L (80-140 mg/dl). If blood glucose ≥11.1 mmol/L was maintained twicely, the approach of insulin administration would convert from subcutaneous injection to venous pump-in using the computerized glucose control protocol. If the infusion rate of insulin was less than 3 U/h and lasted more than 6 hours, blood glucose ≤7.8 mmol/L, insulin administration was switched to subcutaneous injection again. The general information and all glucose regulation data were recorded for analysis.
The two groups did not differ at baseline for the general information, mean blood glucose and the glucose variation. A total of 1689 blood glucose records were analyzed. The mean blood glucose in experiment group, and was significantly lower than that in control group(7.58±1.17 mmol/L vs. 9.40±1.74 mmol/L, P<0.05). The rate of glucose values within target range in experiment group was significantly higher than that in control group [49.72% (534/1074) vs. 35.61% (219/615), P<0.01]. The glucose standard deviation (SD) in experiment group was significantly lower than that in control group (1.89±0.52 mmol/L vs. 2.17±0.94 mmol/L, P<0.05). The number of measurements needed per patient per day was significantly reduced in experiment group compared with control group (7.51±1.31 vs. 8.15±0.97, P<0.05). The ratio of patients converted to venous pump-in was significantly decreased in experiment group compared with control group (9.09% vs. 44.19%, P<0.01). Hypoglycemia (≤3.3 mmol/L) did not different between experiment group and control group [0.74% (8/1074) vs. 0.49% (3/615), P=0.75].
Compared with the conventional subcutaneous insulin injection protocol, this protocol with insulin glargine combined regular insulin subcutaneous injection can control the glucose level effectively during EN in critical patients. The glucose variation and the numbers of measurements were significantly reduced by this protocol. It is helpful for the insulin transmission from venous pump-in to subcutaneous injection.
探讨一种有效且安全的肠内营养（EN）患者方案，以成功实现胰岛素给药从静脉泵入转换为皮下注射。
进行一项前瞻性随机对照研究。2008年9月至2009年2月入住北京同仁医院重症监护病房（ICU）的重症患者，当肠内营养提供的能量达到总能量需求的一半时，随机分为两组。实验组（n = 44）：应用甘精胰岛素和常规胰岛素注射方案；对照组（n = 43）：应用皮下常规胰岛素注射方案。目标血糖范围为4.4 - 7.8 mmol/L（80 - 140 mg/dl）。若血糖≥11.1 mmol/L持续出现两次，则采用计算机化血糖控制方案将胰岛素给药途径从皮下注射转换为静脉泵入。若胰岛素输注速率小于3 U/h且持续超过6小时，血糖≤7.8 mmol/L，则胰岛素给药再次转换为皮下注射。记录一般信息和所有血糖调节数据进行分析。
两组在一般信息、平均血糖和血糖变化方面基线无差异。共分析1689条血糖记录。实验组平均血糖显著低于对照组（7.58±1.17 mmol/L对9.40±1.74 mmol/L，P<0.05）。实验组目标范围内血糖值的比例显著高于对照组[49.72%（534/1074）对35.61%（219/615），P<0.01]。实验组血糖标准差（SD）显著低于对照组（1.89±0.52 mmol/L对2.17±0.94 mmol/L，P<0.05）。与对照组相比，实验组每位患者每天所需测量次数显著减少（7.51±1.31对8.15±0.97，P<0.05）。与对照组相比，实验组转换为静脉泵入的患者比例显著降低（9.09%对44.19%，P<0.01）。实验组和对照组低血糖（≤3.3 mmol/L）情况无差异[0.74%（8/1074）对0.49%（3/615），P = 0.75]。
与传统皮下胰岛素注射方案相比，这种甘精胰岛素联合常规胰岛素皮下注射方案可有效控制重症患者肠内营养期间的血糖水平。该方案显著降低了血糖变化和测量次数。有助于胰岛素从静脉泵入转换为皮下注射。
