微量泵持续静脉输注胰岛素优化方案的应用

doi:10.3761/j.issn.0254-1769.2023.10.003

摘要/Abstract

摘要：

目的落实以波特兰草案为依据的微量泵持续静脉输注胰岛素优化方案，改善急性心肌梗死合并2型糖尿病患者行经皮冠状动脉介入术后血糖水平。方法 2021年3月—2022年2月将122例急性心肌梗死合并2型糖尿病行经皮冠状动脉介入术患者随机分为试验组和对照组，试验组采取静脉微量泵持续输注胰岛素优化方案，对照组依据波特兰草案调控血糖。采用平均血糖值、血糖标准差、平均血糖波动幅度、餐后血糖波动幅度及葡萄糖目标范围内时间评价患者在住院期间的血糖控制水平。结果两组的平均血糖值、血糖标准差及平均血糖波动幅度均降低，差异均具有统计学意义（P<0.05），餐后血糖波动幅度差异无统计学意义（P=0.154）；两组住院期间葡萄糖目标范围内时间比较，差异均具有统计学意义（P<0.05）。结论护士通过实施微量泵持续静脉输注胰岛素优化方案可减小患者血糖波动幅度，提高葡萄糖目标范围内时间。

关键词: 急性心肌梗死, 2型糖尿病, 波特兰草案, 胰岛素, 微量泵, 护理

Abstract:

Objective To optimize the scheme of continuous intravenous insulin infusion with micro-pump based on Portland protocol，to improve blood glucose level in patients with acute myocardial infarction complicated with type 2 diabetes mellitus after percutaneous coronary intervention. Methods 122 patients with acute myocardial infarction complicated with type 2 diabetes undergoing percutaneous coronary intervention were randomly divided into a control group and an experimental group from March 2021 to February 2022. The patients of the control group received measures according to Portland protocol，and patients of the experimental group received the optimized scheme based on Portland protocol. The mean blood glucose，standard deviation of blood glucose，mean amplitude of glycemic excursion，postprandial glucose excursion and time in ranges were used to evaluate effectiveness of the scheme during hospitalization. Results The average blood glucose，standard deviation of blood glucose，mean amplitude of glycemic excursion and time in ranges in the experimental group were lower than those in the control group，and the differences were statistically significant（P<0.05）. The postprandial glucose excursion in the 2 groups was not statistically significant（P=0.154）. Conclusion The optimized scheme can improve blood glucose in patients with acute myocardial infarction complicated with type 2 diabetes after percutaneous coronary intervention，and significantly increase time in range.

Key words: Acute Myocardial Infarction, Type 2 Diabetes Mellitus, Portland Protocol, Insulin, Micro-Pump, Nursing Care

田凤美, 谭丽萍, 陆亚琼, 黄慧, 赵丽爽. 微量泵持续静脉输注胰岛素优化方案的应用[J]. 中华护理杂志, 2023, 58(10): 1172-1177.

TIAN Fengmei, TAN Liping, LU Yaqiong, HUANG Hui, ZHAO Lishuang. Application of the optimized scheme of continuous intravenous insulin infusion with micro-pump[J]. Chinese Journal of Nursing, 2023, 58(10): 1172-1177.

图/表 3

表1 两组一般资料比较

Table 1 Comparison of general data between the 2 groups

表2 两组住院期间血糖波动评价指标的比较（mmol/L, $\bar{x}±s$）

Table 2 Comparison of glycemic indicators between 2 groups during hospitalization（mmol/L, $\bar{x}±s$）

表3 两组血糖控制水平比较（%，$\bar{x}±s$）

Table 3 Comparison of glucose control level between 2 groups（%，$\bar{x}±s$）

参考文献 19

[1]	Windecker S, Kolh P, Alfonso F, et al. 2014 ESC/EACTS guidelines on myocardial revascularization:the task force on myocardial revascularization of the European Society of Cardiology(ESC) and the European Association of Cardio-Thoracic Surgery(EACTS) developed with the special contribution of the European Association of Percutaneous Cardiovascular Intervention(EAPCI)[J]. Eur Heart J, 2014, 35(37):2541-2619. DOI PMID
[2]	Kosiborod M, Rathore SS, Inzucchi SE, et al. Admission glucose and mortality in elderly patients hospitalized with acute myocardial infarction:implications for patients with and without recognized diabetes[J]. Circulation, 2005, 111(23):3078-3086. DOI PMID
[3]	Furnary AP, Gao GQ, Grunkemeier GL, et al. Continuous insulin infusion reduces mortality in patients with diabetes undergoing coronary artery bypass grafting[J]. J Thorac Cardiovasc Surg, 2003, 125(5):1007-1021. DOI URL
[4]	刘岩, 任思思, 杜丽梅. 微量泵泵入胰岛素治疗糖尿病酮症酸中毒效果观察[J]. 继续医学教育, 2019, 33(1):138-139.
	Liu Y, Ren SS, Du LM. The effect of micropump insulin injection on diabetic ketoacidosis[J]. Continuing Med Educ, 2019,(1):138-139.
[5]	刘伟权, 黄素芳, 肖琦, 等. 改良波特兰草案在危重症患者应激性高血糖管理中的应用[J]. 中国实用护理杂志, 2015, 31(3):186-188.
	Liu WQ, Huang SF, Xiao Q, et al. Modified Portland draft in the management of stress hyperglycemia in critically ill patients[J]. Chin J Pract Nurs, 2015, 31(3):186-188.
[6]	张珊, 庞旭峰, 万香玉, 等. ICU肠内营养患者高血糖发生现况及影响因素分析[J]. 中华护理杂志, 2019, 54(9):1349-1353. DOI URL
	Zhang S, Pang XF, Wan XY, et al. Investigation and analysis of factors related to hyperglycemia in ICU patients undergoing enteral nutrition[J]. Chin J Nurs, 2019, 54(9):1349-1353. DOI URL
[7]	吴霞, 鞠君华. 糖尿病合并急性心肌梗死患者血糖波动及临床意义[J]. 中国现代医生, 2014, 52(12):36-38.
	Wu X, Ju JH. Clinical significance of glucose fluctuation in patients with diabetes mellitus complicated with AMI[J]. China Mod Dr, 2014, 52(12):36-38.
[8]	Fleischmann KE, Zègre-Hemsey J, Drew BJ. The new universal definition of myocardial infarction criteria improve electrocardiographic diagnosis of acute coronary syndrome[J]. J Electrocardiol, 2011, 44(1):69-73. DOI PMID
[9]	中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2013年版)[J]. 中国糖尿病杂志, 2014, 22(8):2-42.
	Chinese Diabetes Society. Guideline for the prevention and treatment of type 2 diabetes mellitus in China(2020 edition)[J]. Chin J Diabetes, 2014, 22(8):2-42.
[10]	孟瑶, 付明明, 赵雨琪, 等. 《2020年版围术期血糖管理专家共识》解读[J]. 河北医科大学学报, 2022, 43(1):1-6,11.
	Meng Y, Fu MM, Zhao YQ, et al. Interpretation of the 2020 edition of the expert consensus on perioperative glucose management[J]. J Hebei Med Univ, 2022, 43(1):1-6,11.
[11]	李海, 李延兵. 《葡萄糖目标范围内时间国际共识》解读[J]. 中华糖尿病杂志, 2019(12):825-827.
	Li H, Li YB. International consensus on time in range[J]. Chin J Diabetes Mellit, 2019(12):825-827.
[12]	American Diabetes Association. 15. diabetes care in the hospital:standards of medical care in diabetes-2021[J]. Diabetes Care, 2021, 44(Suppl 1):S211-S220. DOI URL
[13]	赵芳, 张明霞, 莫永珍, 等. 外科护士围手术期血糖管理的现状调查[J]. 中华护理杂志, 2019, 54(10):1524-1528. DOI URL
	Zhao F, Zhang MX, Mo YZ, et al. Survey on perioperative period blood glucose management among surgical nurses[J]. Chin J Nurs, 2019, 54(10):1524-1528. DOI URL
[14]	伍静, 孙秋虹, 杨华. 不同血糖控制方案对急性重症胰腺炎患者血糖变异性的影响[J]. 中华医学杂志, 2015, 95(19):1496-1500.
	Wu J, Sun QH, Yang H. Effects of blood glucose control on glucose variability and clinical outcomes in patients with severe acute pancreatitis in intensive care unit[J]. Natl Med J China, 2015, 95(19):1496-1500.
[15]	Roth J, Sommerfeld O, Birkenfeld AL, et al. Blood sugar targets in surgical intensive care:management and special considerations in patients with diabetes[J]. Dtsch Arztebl Int, 2021, 118(38):629-636.
[16]	Paliosa AK, Teixeira C, Rosa RG, et al. Hyperglycemia in critical patients:determinants of insulin dose choice[J]. Rev Assoc Med Bras(1992), 2017, 63(5):441-446.
[17]	Lan N, Zhang L, Zhou YJ, et al. Insulin for hyperglycemia prevention and management during postgastrectomy nutrition support in gastric cancer:reduced complications in a retrospective cohort study in China[J]. Asia Pac J Clin Nutr, 2022, 31(1):49-56.
[18]	凌青, 陈玉红. 冠状动脉旁路移植术后应激性高血糖患者血糖波动评估参数研究[J]. 中华护理杂志, 2019, 54(9):1297-1301. DOI URL
	Ling Q, Chen YH. Correlation between blood glucose instability index and postoperative complications in patients with stress hyperglycemia after coronary artery bypass grafting[J]. Chin J Nurs, 2019, 54(9):1297-1301. DOI URL
[19]	付威, 李青菊, 李俊, 等. 动态血糖监测及葡萄糖目标范围内时间对妊娠期糖尿病患者妊娠结局的影响研究[J]. 中国全科医学, 2021, 24(33):4251-4254,4260. DOI
	Fu W, Li QJ, Li J, et al. Impact of continuous glucose monitoring and time-in-range on pregnancy outcome in patients with gestational diabetes mellitus[J]. Chin Gen Pract, 2021, 24(33):4251-4254,4260.