Crespo Jeiel Carlos Lamonica, Gomes Vanessa Rossato, Barbosa Ricardo Luís, Padilha Katia Grillo, Secoli Silvia Regina
Nursing Department, Instituto do Coração (Heart Institute), Hospital das Clínicas da Escola de Medicina da Universidade de São Paulo, Brazi.
Nursing Department, Instituto do Coração (Heart Institute), Hospital das Clínicas da Escola de Medicina da Universidade de São Paulo, Brazil.
Br J Nurs. 2017 Mar 9;26(5):281-286. doi: 10.12968/bjon.2017.26.5.281.
This study aimed to determine hypoglycemia incidence and associated factors in critically ill patients. It looked at a retrospective cohort with 106 critically ill adult patients with 48 hours of glycaemic control and 72 hours of follow up. The dependent variable, hypoglycaemia (≤70 mg/dl), was assessed with respect to independent variables: age, diet, insulin, catecholamines, haemodialysis, nursing workload and the Simplified Acute Physiology Score. Statistical analysis was performed using Student's t-test, Fisher's exact test and logistic regression at 5% significance level. Incidence of hypoglycaemia was 14.2%. Hypoglycaemia was higher in the group of patients on catecholamines (p=0.040), with higher glycaemic variability (p<0.001) and death in the intensive care unit (p=0.008). Risk factors were identified as absence of oral diet (OR 5.11; 95% CI 1.04-25.10) and haemodialysis (OR 4.28; 95% CI 1.16-15.76). Patients on haemodialysis and with no oral diet should have their glycaemic control intensified in order to prevent and/or manage hypoglycaemic episodes.
本研究旨在确定危重症患者低血糖的发生率及相关因素。该研究观察了一个回顾性队列，其中包括106例成年危重症患者，对其进行了48小时的血糖控制及72小时的随访。针对年龄、饮食、胰岛素、儿茶酚胺、血液透析、护理工作量和简化急性生理学评分等自变量评估了因变量低血糖（≤70mg/dl）。使用学生t检验、Fisher精确检验和逻辑回归在5%显著性水平下进行统计分析。低血糖发生率为14.2%。使用儿茶酚胺的患者组低血糖发生率更高（p=0.040），血糖变异性更高（p<0.001），且在重症监护病房的死亡率更高（p=0.008）。危险因素被确定为未进行口服饮食（比值比5.11；95%置信区间1.04 - 25.10）和血液透析（比值比4.28；95%置信区间1.16 - 15.76）。接受血液透析且未进行口服饮食的患者应加强血糖控制，以预防和/或处理低血糖发作。
