Raurell Torredà Marta, del Llano Serrano César, Almirall Solsona Dolors, Catalan Ibars Rosa María, Nicolás Arfelis José María
Facultad de Enfermería, Universidad de Girona, Girona, España.
Unidad de Cuidados Intensivos, Consorcio Hospitalario de Vic-Hospital General de Vic, Vic, Barcelona, España.
Med Clin (Barc). 2014 Mar 4;142(5):192-9. doi: 10.1016/j.medcli.2012.11.032. Epub 2013 Mar 13.
Recent studies in critically ill patients receiving insulin intravenous therapy (IIT) have shown an increased incidence of severe hypoglycemia, while intermittent subcutaneous insulin «sliding scales» (conventional insulin therapy [CIT]) is associated with hyperglycemia. The objective of this study is to assess whether glycemic control range IIT can affect glucose levels and their variability and to compare it with CIT.
Prospective comparative cohort study in intensive care unit, with 2 study periods: Period 1, IIT with glycemic target range 110-140 mg/dL, and Period 2, IIT of 140-180 mg/dL. In both periods CIT glycemic target was 110-180 mg/dL. We assessed severe hypoglycemia (< 50 mg/dL), moderate hypoglycemia (51-79 mg/dL), hyperglycemia (> 216 mg/L) and the variability of blood glucose.
We studied 221 patients with 12.825 blood glucose determinations. Twenty-six and 17% of patients required IIT for glycemic control in Period 1 and 2, respectively. Hypoglycemia was associated with a discontinuous nutritional intake, glycemic target 110-140 mg/dL and low body mass index (BMI) (P = .002). Hyperglycemia was exclusively associated with a history of diabetes mellitus (OR 2.6 [95% CI 1.6 to 4.5]). Glycemic variability was associated with a discontinuous nutritional intake, low BMI, CIT insulinization, diabetes mellitus, elderly and high APACHE II (P < .001).
The use of IIT is useful to reduce the variability of blood glucose. Although the 140-180 mg/dL range would be more secure as to presenting greater variability and hyperglycemia, the 110-140 mg/dL range is most suitable.
近期针对接受静脉胰岛素治疗（IIT）的重症患者的研究显示，严重低血糖的发生率有所增加，而间歇性皮下胰岛素“滑动剂量”（传统胰岛素治疗[CIT]）则与高血糖相关。本研究的目的是评估IIT的血糖控制范围是否会影响血糖水平及其变异性，并将其与CIT进行比较。
在重症监护病房进行前瞻性比较队列研究，有2个研究阶段：第1阶段，血糖目标范围为110 - 140 mg/dL的IIT；第2阶段，血糖目标范围为140 - 180 mg/dL的IIT。在两个阶段中，CIT的血糖目标均为110 - 180 mg/dL。我们评估了严重低血糖（< 50 mg/dL）、中度低血糖（51 - 79 mg/dL）、高血糖（> 216 mg/L）以及血糖变异性。
我们对221例患者进行了12825次血糖测定。在第1阶段和第2阶段，分别有26%和17%的患者需要IIT来控制血糖。低血糖与营养摄入不连续、血糖目标为110 - 140 mg/dL以及低体重指数（BMI）相关（P = 0.002）。高血糖仅与糖尿病病史相关（比值比2.6 [95%置信区间1.6至4.5]）。血糖变异性与营养摄入不连续、低BMI、CIT胰岛素治疗、糖尿病、老年以及高急性生理学与慢性健康状况评分系统II（APACHE II）相关（P < 0.001）。
使用IIT有助于降低血糖变异性。尽管140 - 180 mg/dL范围在血糖变异性和高血糖方面可能更安全，但110 - 140 mg/dL范围最为合适。
