Rodriguez-Calero M A, Barceló Llodrá E, Cruces Cuberos M, Blanco-Mavillard I, Pérez Axartell M A
Unidad de Calidad, Docencia e Investigación, Hospital de Manacor, Manacor, Mallorca, España.
Área del Paciente Crítico, Hospital de Manacor, Manacor, Mallorca, España.
Enferm Intensiva (Engl Ed). 2019 Jan-Mar;30(1):4-12. doi: 10.1016/j.enfi.2018.01.004. Epub 2018 Jun 20.
To assess the effectiveness of the implementation of a protocol for glycaemic control in critical care, in terms of maintenance of a pre-established target of blood glucose level, reduction of hyperglycaemia and prevention of severe hypoglycaemia.
Prospective "pre-post" quasi-experimental study carried out in a general critical care unit. Adult patients treated with intravenous insulin were included. We recorded all glycaemic tests performed from November 2014 to August 2015 (pre-intervention) and from November 2015 to August 2016 (post-intervention). The intervention consisted of the implementation of an evidence-based glycaemic control protocol to achieve glycaemic levels in a range of 140-180mg/dl. Main variables analysed were: proportion of glycaemic tests in the target range, proportions of severe hypoglycaemia (under 40mg/dl) and hyperglycaemia over 200mg/dl.
We analysed 7864 glycaemic tests from 125 patients, 66 pre-intervention and 59 post-intervention. Average age was 66.24±13.99 years, 64% of patients were male. The proportion of tests within the target range was higher in the intervention group (38.82 vs. 44.34 p<.001). Only one case of severe hypoglycaemia was identified, which happened in the pre-intervention period. The rate of severe hyperglycaemia was lower in the post-intervention group (19.19 vs. 16.28 p=.001).
Our experience shows that implementation of evidence-based interventions can improve glycaemic control during critical illness. We found higher glycaemia levels in the target range. The protocol proved useful in the prevention of severe hypoglycaemia. Nurse-led interventions based on clinical data improved health results in our patients.
根据维持预先设定的血糖水平目标、降低高血糖症以及预防严重低血糖症，评估在重症监护中实施血糖控制方案的有效性。
在一家普通重症监护病房进行前瞻性“干预前后”准实验研究。纳入接受静脉胰岛素治疗的成年患者。我们记录了2014年11月至2015年8月（干预前）以及2015年11月至2016年8月（干预后）进行的所有血糖检测。干预措施包括实施基于证据的血糖控制方案，以使血糖水平达到140 - 180mg/dl的范围。分析的主要变量有：目标范围内血糖检测的比例、严重低血糖（低于40mg/dl）的比例以及高于200mg/dl的高血糖症比例。
我们分析了125例患者的7864次血糖检测，干预前6组，干预后59组。平均年龄为66.24±13.99岁，64%的患者为男性。干预组目标范围内检测的比例更高（38.82对44.34，p<0.001）。仅发现1例严重低血糖病例，发生在干预前期。干预后组严重高血糖症的发生率较低（19.19对16.28，p = 0.001）。
我们的经验表明，实施基于证据的干预措施可改善危重症期间的血糖控制。我们发现目标范围内的血糖水平更高。该方案在预防严重低血糖方面被证明是有用的。基于临床数据由护士主导的干预改善了我们患者的健康状况。
