动态血糖监测可维持ICU患者病情平稳

据欧洲糖尿病研究学会(EASD)年会上报告的一项研究结果，使用皮下动态血糖监测系统可使接受重症监护的危重患者更好地控制血糖水平；与通过即时检测进行监测的患者相比，采用动态监测的患者血糖处于目标血糖范围内的时间明显延长。


Daphne Boom女士

在这项研究中，阿姆斯特丹圣母医院（OLVG）的Daphne Boom及其同事在177名被收治入住重症监护病房且预期至少要住24小时的患者中对比了两种监测方案：87人被随机分配到动态皮下血糖监测组，90人被分配到即时监测组。两组的目标血糖范围均为5~9 mmol/L。动态血糖监测系统每10分钟测一次血糖，只要记录值超出范围就会发出报警声；即时血糖监测组患者每2小时采集一次血样。两组患者均采用同一种计算机算法根据监测系统水平或指尖血样给出胰岛素剂量建议。两组均每隔6小时由动脉血样提供一个参考血糖范围，但血样仅用于校正用药，不对医生透露。主要终点为严重低血糖（<2.2 mmol/L）和严重高血糖（>25 mmol/L）的发生率。效力的衡量标准为血糖维持在目标范围内的时长。护理工作量则用每24小时血液采样次数衡量。大多数患者来自于医疗服务机构；其中13%为复杂心脏手术患者，且大多数（92%）患者使用呼吸机。研究者审视了1,358条配对测量结果。

结果显示，在干预组中有5例严重低血糖事件，对照组中有2例，但该差异不具有统计学意义。两均中均未出现严重高血糖。在两组中各有1例轻度低血糖。在干预组中有1例轻度高血糖，在对照组中则有2例。干预组的平均研究时长为73小时，其中58例（79%）患者在此期间血糖处于目标范围内。对照组的平均研究时长为59小时，其中43例（73%）患者在此期间血糖处于目标范围内，该差异具有统计学意义。干预组血样采集次数明显较低（每24小时2次 vs. 12次），表明动态监测系统可以更有效地利用护理时间。

Boom女士表示自己没有相关的利益冲突。

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By: MICHELE G. SULLIVAN, Cardiology News Digital Network

BARCELONA – Use of a subcutaneous continuous glucose monitoring system translated into better glycemic control for critically ill patients in intensive care, a study has shown.

Compared with those monitored by point-of-care testing, patients with continuous monitoring spent significantly more time in their target blood glucose range, Daphne Boom reported at the annual meeting of the European Association for the Study of Diabetes.

The implantable device also markedly reduced the need for blood samples, said Ms. Boom, a medical student at the Onze Lieve Vrouwe Gasthuis, Amsterdam. Nurses obtained a mean of just two samples over a 24-hour period for these patients, compared with 12 over the same time for point-of-care patients.
 
Ms. Boom and her colleagues compared the two monitoring regimens in a group of 177 patients who were admitted to intensive care with an expected stay of at least 24 hours; 87 were randomized to continuous subcutaneous glucose monitoring and 90 to point-of-care monitoring. The target glucose range for each group was 5-9 mmol/L. The continuous monitoring system measured glucose every 10 minutes, and sounded an alarm whenever it registered outside this parameter. Blood samples were drawn every 2 hours for the point-of-care patients. A computer algorithm made insulin dosing recommendations for patients in both groups, based on the monitoring system level or the results of finger-stick samples.

In both groups, an arterial blood sample provided a reference glucose range every 6 hours; however, the samples were blinded to clinicians and used only for calibrating medications.

The primary endpoints were the incidence of severe hypoglycemia (below 2.2 mmol/L) and severe hyperglycemia (above 25 mmol/L). The measure of efficacy was the total time spent within the blood glucose target range. Nursing workload was assessed by the number of blood samples drawn every 24 hours.

Most patients were from the medical service; 13% were complicated cardiac surgery patients. The majority (92%) were mechanically ventilated. The investigators looked at 1,358 paired measurements.

There were five incidents of severe hypoglycemia in the intervention group and two in the control group, but the difference was not statistically significant. There were no cases of severe hyperglycemia in either group.

There was one case of mild hypoglycemia in each group. There was one case of mild hyperglycemia in the intervention group and two in the control group.

The mean study duration was 73 hours for the intervention group, of which 58 (79%) were spent within the target glucose range. The mean study duration for the control group was 59 hours, of which 43 (73%) were spent in the target range. This difference was statistically significant.

Significantly fewer blood samples were drawn from the intervention group (2 vs. 12 every 24 hours), showing that the continuous monitoring system was a more efficient use of nursing time, Ms. Boom added.

She said she had no relevant financial disclosures.