Genay Stéphanie, Décaudin Bertrand, Ethgen Sabine, Alluin Arnaud, Babol Elodie, Labreuche Julien, Behal Hélène, Vantyghem Marie-Christine, Odou Pascal, Lebuffe Gilles
EA 7365 - GRITA - Groupe de Recherche sur les formes Injectables et les Technologies Associées, University of Lille, CHU Lille, 59000, Lille, France.
Institut de Pharmacie, CHU Lille, 59000, Lille, France.
Ann Intensive Care. 2017 Dec;7(1):74. doi: 10.1186/s13613-017-0298-x. Epub 2017 Jul 11.
Glucose control is an important issue in post-operative patients. The objective here was to compare two insulin infusion lines by syringe pumps to assess the impact of medical devices on glycaemic variability in surgical patients under intensive insulin therapy. This open, prospective, single-centre randomised study was conducted in a fifteen-bed perioperative high dependency unit (HDU) in a university hospital. In total, 172 eligible patients receiving insulin therapy agreed to participate in the study. Subcutaneous continuous glucose monitoring was set up for all patients and an optimised system with a dedicated insulin infusion line for half of the patients.
Eighty-six patients were infused via the optimised infusion line and 86 patients via the standard infusion line. No significant difference was found according to the glycaemic lability index score [mean difference between groups (95% CI): -0.09 (-0.34; 0.16), p = 0.49 after multiple imputation]. A glucose control monitoring system indicated a trend towards differences in the duration of hypoglycaemia (blood glucose level below 70 mg dl (3.9 mmol l) over 1000 h of insulin infusion (9.7 ± 25.0 h in the standard group versus 4.4 ± 14.8 h in the optimised group, p = 0.059) and in the number of patients experiencing at least one hypoglycaemia incident (25.7 vs. 12.9%, p = 0.052). Time in the target range was similar for both groups.
The use of optimised infusion line with a dedicated insulin infusion line did not reduce glycaemic variability but minimised the incidence of hypoglycaemia events. The choice of the medical devices used to infuse insulin seems important for improving the safety of insulin infusion in perioperative HDU.
血糖控制是术后患者的一个重要问题。本研究的目的是比较两种通过注射泵输注胰岛素的方式，以评估医疗设备对接受强化胰岛素治疗的手术患者血糖变异性的影响。这项开放、前瞻性、单中心随机研究在一所大学医院的一个拥有15张床位的围手术期高依赖病房（HDU）中进行。共有172名接受胰岛素治疗的符合条件的患者同意参与该研究。为所有患者设置了皮下连续血糖监测，并为一半的患者配备了带有专用胰岛素输注管路的优化系统。
86名患者通过优化输注管路输注胰岛素，86名患者通过标准输注管路输注胰岛素。根据血糖不稳定指数评分未发现显著差异[组间平均差异（95%CI）：-0.09（-0.34；0.16），多次插补后p = 0.49]。血糖控制监测系统显示，低血糖持续时间存在差异趋势（胰岛素输注1000小时期间血糖水平低于70 mg/dl（3.9 mmol/l））（标准组为9.7±25.0小时，优化组为4.4±14.8小时，p = 0.059），以及至少发生一次低血糖事件的患者数量存在差异趋势（25.7%对12.9%，p = 0.052）。两组在目标范围内的时间相似。
使用带有专用胰岛素输注管路的优化输注管路并未降低血糖变异性，但将低血糖事件的发生率降至最低。用于输注胰岛素的医疗设备的选择对于提高围手术期HDU中胰岛素输注的安全性似乎很重要。
