近连续血糖监测使 ICU 患者的血糖控制更安全。

Near-Continuous Glucose Monitoring Makes Glycemic Control Safer in ICU Patients.

机构信息

Department of Intensive Care, Erasme University Hospital, Université libre de Bruxelles, Brussels, Belgium.

Edwards Lifesciences, Irvine, CA.

出版信息

Crit Care Med. 2018 Aug;46(8):1224-1229. doi: 10.1097/CCM.0000000000003157.

DOI:10.1097/CCM.0000000000003157

PMID:29677007

Abstract

OBJECTIVES

Tight glycemic control using intermittent blood glucose measurements is associated with a risk of hypoglycemia. Glucose concentrations can now be measured near continuously (every 5-15 min). We assessed the quality and safety of glycemic control guided by a near-continuous glucose monitoring system in ICU patients.

DESIGN

Prospective, cluster-randomized, crossover study.

SETTING

Thirty-five-bed medico-surgical department of intensive care with four separate ICUs.

PATIENTS

Adult patients admitted to the department and expected to stay for at least 3 days were considered for inclusion if they had persistent hyperglycemia (blood glucose > 150 mg/dL) up to 6 hours after admission and/or were receiving insulin therapy.

INTERVENTIONS

A peripheral venous catheter was inserted in all patients and connected to a continuous glucose monitoring sensor (GlucoClear; Edwards Lifesciences, Irvine, CA). The four ICUs were randomized in pairs in a crossover design to glycemic control using unblinded or blinded continuous glucose monitoring monitors. The insulin infusion rate was adjusted to keep blood glucose between 90 and 150 mg/dL using the blood glucose values displayed on the continuous glucose monitor (continuous glucose monitoring group-unblinded units) or according to intermittent blood glucose readings (intermittent glucose monitoring group-blinded units).

MEASUREMENTS AND MAIN RESULTS

The quality and safety of glycemic control were assessed using the proportion of time in range, the frequency of blood glucose less than 70 mg/dL, and the time spent with blood glucose less than 70 mg/dL (TB70), using blood glucose values measured by the continuous glucose monitoring device. Seventy-seven patients were enrolled: 39 in the continuous glucose monitoring group and 38 in the intermittent glucose monitoring group. A total of 43,107 blood glucose values were recorded. The time in range was similar in the two groups. The incidence of hypoglycemia (8/39 [20.5%] vs 15/38 [39.5%]) and the TB70 (0.4% ± 0.9% vs 1.6% ± 3.4%; p < 0.05) was lower in the continuous glucose monitoring than in the intermittent glucose monitoring group.

CONCLUSIONS

Use of a continuous glucose monitoring-based strategy decreased the incidence and severity of hypoglycemia, thus improving the safety of glycemic control.

摘要

目的

使用间歇性血糖测量进行严格的血糖控制与低血糖风险相关。现在可以近乎连续（每 5-15 分钟）测量血糖浓度。我们评估了 ICU 患者使用近连续血糖监测系统指导的血糖控制的质量和安全性。

设计

前瞻性、集群随机、交叉研究。

设置

35 张病床的内科-外科重症监护病房，有四个单独的 ICU。

患者

如果患者在入院后 6 小时内持续高血糖（血糖>150mg/dL）和/或正在接受胰岛素治疗，则将其纳入符合条件的成年患者，并预计至少在该部门停留 3 天。

干预

所有患者均插入外周静脉导管，并连接到连续血糖监测传感器（GlucoClear；爱德华生命科学公司，欧文，加利福尼亚州）。四个 ICU 以配对方式随机分为两组，使用未盲或盲目的连续血糖监测仪进行血糖控制。使用连续血糖监测仪上显示的血糖值（连续血糖监测组-未盲单位）或根据间歇性血糖读数（间歇性血糖监测组-盲单位）调整胰岛素输注率，以将血糖保持在 90 至 150mg/dL 之间。

测量和主要结果

使用连续血糖监测仪测量的血糖值评估血糖控制的质量和安全性，包括达标时间比例、血糖低于 70mg/dL 的频率以及血糖低于 70mg/dL 的时间（TB70）。77 名患者入组：连续血糖监测组 39 名，间歇性血糖监测组 38 名。共记录了 43107 个血糖值。两组的达标时间相似。连续血糖监测组低血糖发生率（8/39 [20.5%] vs 15/38 [39.5%]）和 TB70（0.4%±0.9%vs 1.6%±3.4%；p<0.05）低于间歇性血糖监测组。