The Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong.
Faculty of Medicine and Health Science, University of Nottingham, Clifton Boulevard, Nottingham, NG7 2RD, UK.
Perioper Med (Lond). 2012 Oct 6;1:7. doi: 10.1186/2047-0525-1-7. eCollection 2012.
Perioperative hyperglycaemia is associated with poor outcomes in patients undergoing cardiac surgery. Frequent postoperative hyperglycaemia in cardiac surgery patients has led to the initiation of an insulin infusion sliding scale for quality improvement. A systematic review was conducted to determine whether a protocol-directed insulin infusion sliding scale is as safe and effective as a conventional practitioner-directed insulin infusion sliding scale, within target blood glucose ranges. A literature survey was conducted to identify reports on the effectiveness and safety of an insulin infusion protocol, using seven electronic databases from 2000 to 2012: MEDLINE, CINAHL, EMBASE, the Cochrane Library, the Joanna Briggs Institute Library and SIGLE. Data were extracted using pre-determined systematic review and meta-analysis criteria. Seven research studies met the inclusion criteria. There was an improvement in overall glycaemic control in five of these studies. The implementation of protocols led to the achievement of blood glucose concentration targets more rapidly and the maintenance of a specified target blood glucose range for a longer time, without any increased frequency of hyperglycaemia. Of the seven studies, four used controls and three had no controls. In terms of the meta-analysis carried out, four studies revealed a failure of patients reaching target blood glucose levels (P < 0.0005) in the control group compared with patients in the protocol group. The risk of hypoglycaemia was significantly reduced (P <0.00001) between studies. It can be concluded that the protocol-directed insulin infusion sliding scale is safe and improves blood glucose control when compared with the conventional practitioner-directed insulin infusion sliding scale. This study supports the adoption of a protocol-directed insulin infusion sliding scale as a standard of care for post-cardiac surgery patients.
围手术期高血糖与心脏手术患者的不良预后有关。心脏手术患者术后经常出现高血糖，这导致启动了胰岛素输注量调整方案以提高质量。进行了系统评价，以确定在目标血糖范围内，方案指导的胰岛素输注量调整方案是否与常规医生指导的胰岛素输注量调整方案一样安全有效。进行了文献调查，以确定使用从 2000 年到 2012 年的七个电子数据库（MEDLINE、CINAHL、EMBASE、Cochrane 图书馆、Joanna Briggs 研究所图书馆和 SIGLE）报道的胰岛素输注方案的有效性和安全性。使用预先确定的系统评价和荟萃分析标准提取数据。有 7 项研究符合纳入标准。其中 5 项研究的整体血糖控制得到改善。方案的实施使血糖浓度目标更快地达到，并且更长时间地维持特定的目标血糖范围，而没有更高的高血糖频率。在这 7 项研究中，有 4 项使用了对照，3 项没有对照。就进行的荟萃分析而言，与方案组相比，对照组中有 4 项研究表明患者达到目标血糖水平的失败率更高（P <0.0005）。研究之间低血糖的风险显著降低（P <0.00001）。可以得出结论，与常规医生指导的胰岛素输注量调整方案相比，方案指导的胰岛素输注量调整方案更安全，并且可以改善血糖控制。本研究支持采用方案指导的胰岛素输注量调整方案作为心脏手术后患者的护理标准。
