Thomas S H, Gough J E, Benson N, Austin P E, Stone C K
Department of Emergency Medicine, East Carolina University School of Medicine, University Medical Center of Eastern Carolina, Greenville, NC 27858-4354.
South Med J. 1994 Nov;87(11):1072-5. doi: 10.1097/00007611-199411000-00003.
Recent demonstration of the dangers of hyperglycemia in the setting of cerebral hypoperfusion has resulted in recommendations to abandon the long-standing practice of empiric administration of dextrose to patients with altered mental status. Patients receiving basic cardiopulmonary resuscitation (CPR) have been identified as being at particular risk from inappropriate administration of dextrose. We conducted a prospective trial to determine whether the blood glucose of 50 patients receiving CPR could be accurately assessed using a portable rapid-reagent device in the emergency department (ED). We analyzed both capillary and venous blood samples in the rapid-reagent system, using laboratory analysis of venous blood to define the patient's true blood glucose level. Capillary blood analysis identified 8 patients as hypoglycemic; only 3 of these patients were truly hypoglycemic, and 2 patients identified as hypoglycemic by fingerstick were actually hyperglycemic on laboratory analysis. The only instance in which a patient was classified differently by venous rapid-reagent and laboratory analysis occurred when a patient assessed as normoglycemic (169 mg/dL) by the laboratory had a venous rapid-reagent glucose reading of 182 mg/dL (hyperglycemic). We recommend that venous (rather than capillary) blood be used to analyze blood glucose in all patients receiving CPR before dextrose administration is considered.
近期关于脑灌注不足情况下高血糖危险的研究表明，不应再继续长期以来对意识改变患者经验性给予葡萄糖的做法。接受基本心肺复苏（CPR）的患者被认为特别容易因不恰当给予葡萄糖而面临风险。我们进行了一项前瞻性试验，以确定在急诊科（ED）使用便携式快速检测设备能否准确评估50例接受CPR患者的血糖。我们在快速检测系统中分析了毛细血管血和静脉血样本，并通过实验室对静脉血的分析来确定患者的真实血糖水平。毛细血管血分析确定8例患者为低血糖；其中只有3例患者真正为低血糖，另外2例通过指尖检测确定为低血糖的患者经实验室分析实际上为高血糖。静脉快速检测与实验室分析对患者分类不同的唯一情况是，一名经实验室评估血糖正常（169 mg/dL）的患者静脉快速检测葡萄糖读数为182 mg/dL（高血糖）。我们建议，在考虑给予葡萄糖之前，对所有接受CPR的患者应使用静脉血（而非毛细血管血）来分析血糖。
