连续护理班次与接受静脉胰岛素治疗的重症患者发生低血糖的风险：一项多中心研究。

Consecutive nursing shifts and the risk of hypoglycemia in critically ill patients who are receiving intravenous insulin: a multicenter study.

作者信息

Ayas Najib T, Jeklin Andrew T, Tholin Harriet, Rogers Ann E, Dodek Peter, Hirsh-Allen A J, Norena Monica, Wong Hubert

机构信息

Program in Critical Care Medicine, Providence Health Care, Vancouver, British Columbia, Canada.

Critical Care Division, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.

出版信息

J Clin Sleep Med. 2020 Jun 15;16(6):949-953. doi: 10.5664/jcsm.8382.

DOI:10.5664/jcsm.8382

PMID:32065114

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7849663/

Abstract

STUDY OBJECTIVES

Intensive care unit nurses commonly work multiple consecutive 12-hour shifts that leave little time for sleep between work shifts. Working multiple consecutive shifts could compromise vigilance and patient care, especially with respect to managing high-risk medications such as insulin infusions. We hypothesized that as the number of consecutive shifts worked by nurses increases, the rate of hypoglycemia in patients who are receiving an insulin infusion would also increase.

METHODS

We identified patients who had hypoglycemia (glucose ≤ 3.5 mmol/L, 63 mg/dL) between December 2008 and December 2009 in 3 intensive care units in Vancouver, British Columbia, Canada. For each hypoglycemic event, we counted the number of shifts worked on consecutive days during the previous 72 hours by the bedside nurse who was caring for the patient at the time of hypoglycemia (case shift). For each case shift, we identified up to 3 control shifts (24, 48, and 72 hours before the hypoglycemic event in the same patient when there were no hypoglycemic events) and counted the number of consecutive shifts worked by those nurses in the previous 72 hours. This analysis allowed us to control for patient-associated confounders. Conditional logistic regression was used to determine the association between number of consecutive shifts worked and occurrence of hypoglycemic events.

RESULTS

A total of 282 hypoglycemic events were identified in 259 patients. For 191 events, we were able to identify 1 or more control shifts. Compared with nurses who had not worked a shift in the preceding day, the odds ratio of a hypoglycemic event was 1.68 (95% confidence interval: 1.12-2.52), 2.16 (95% confidence interval:1.25-3.73), and 2.54 (95% confidence interval: 1.28-5.06) for nurses who were working their second, third, or fourth consecutive shift, respectively.

CONCLUSIONS

Working multiple consecutive nursing shifts is associated with increased risk of hypoglycemic events in patients in an intensive care unit.

摘要

研究目的

重症监护病房护士通常连续工作多个12小时轮班，轮班之间几乎没有睡眠时间。连续工作多个轮班可能会影响警觉性和患者护理，尤其是在管理胰岛素输注等高风险药物方面。我们假设，随着护士连续工作轮班次数的增加，接受胰岛素输注患者的低血糖发生率也会增加。

方法

我们确定了2008年12月至2009年12月期间在加拿大不列颠哥伦比亚省温哥华市3个重症监护病房发生低血糖（血糖≤3.5 mmol/L，63 mg/dL）的患者。对于每一次低血糖事件，我们计算了在低血糖发生时照顾该患者的床边护士在前72小时内连续工作的轮班次数（病例轮班）。对于每一个病例轮班，我们确定了多达3个对照轮班（同一患者在无低血糖事件时，低血糖事件前24、48和72小时），并计算这些护士在前72小时内连续工作的轮班次数。该分析使我们能够控制与患者相关的混杂因素。采用条件逻辑回归来确定连续工作轮班次数与低血糖事件发生之间的关联。

结果

在259例患者中总共确定了282次低血糖事件。对于191次事件，我们能够确定1个或更多对照轮班。与前一天未工作轮班的护士相比，连续工作第二个、第三个或第四个轮班的护士发生低血糖事件的比值比分别为1.68（95%置信区间：1.12 - 2.52）、2.16（95%置信区间：1.25 - 3.73）和2.54（95%置信区间：1.28 - 5.06）。