危重患者持續靜靜脈血液濾過時血糖監測的影響因素研究_Chinese Journal of Respiratory and Critical Care Medicine

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虞竹溪 , 顧勤 , 劉寧 , 楊樸強

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Keywords：

持續靜靜脈血液濾過; 危重癥; 血糖監測

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目的觀察危重患者持續靜靜脈血液濾過( CVVH) 過程中血糖監測的影響因素。方法選擇CVVH治療的危重患者30 例, 根據其入選時的循環狀態將患者分為休克組和非休克組, 同時監測兩組患者動脈血糖、末梢血糖及CVVH 導管動脈端血糖, 比較同一時點各部位血糖監測值。結果所有患者動脈血糖值與末梢血糖值比較有顯著差異( P lt; 0. 05) , 動脈血糖值與CVVH 導管動脈端血糖值差異無統計學意義( P gt; 0. 05) , 且二者存在明顯相關性( r = 0. 989, P lt; 0. 001) , 末梢血糖值與CVVH導管動脈端血糖值差異有統計學意義( P lt;0. 05) ; 休克組末梢血糖值較動脈血糖值低, 差異有統計學意義( P lt; 0. 05) , 非休克組末梢血糖值與動脈血糖值差異無統計學意義( P gt;0. 05) 。結論危重患者末梢血糖監測值偏低, 該差異在休克患者中更加明顯; CVVH時可通過導管動脈端采血監測血糖。

Citation： 虞竹溪,顧勤,劉寧,楊樸強. 危重患者持續靜靜脈血液濾過時血糖監測的影響因素研究. Chinese Journal of Respiratory and Critical Care Medicine, 2010, 9(1): 85-87. doi: Copy

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7.	Coursin DB,Connery LE,Ketzler JT. Perioperative diabetic and hyperglycemic management issues.Crit Care Med,2004,32:S116-S125.
8.	Finkielman JD,Oyen LJ,Afessa B,et al. Agreement Between Bedside Blood and Plasma Glucose Measurement in the ICU Setting.Chest,2005,127:1749-1751.
9.	Desachy A,Vuagnat AC,Ghazali AD,et al. Accuracy of Bedside Glucometry in Critically Ill Patients: Influence of Clinical Characteristics and Perfusion Index.Mayo Clin Proc,2008,83:400-405.
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11.	謝平初,陸家齊,孫大銘,等.豬內毒素休克外周與內臟微循環灌注的動態變化.中國危重病急救醫學,1999,11:718-720.
12.	季大璽,謝紅浪,黎磊石.連續性血液凈化與非腎臟疾病.中國危重病急救醫學,2001,13:5-9.
13.	Read JL,Cheng EY.Intensive insulin therapy for acute hyperglycemia. AACN Adv Crit Care,2007,18:200-212.
14.	Harper J,Glucose control in the intensive care unit: how it is done. Proc Nutr Soc,2007,66:362-366.

1. Van den Berghe G,WilmerA,Hermans G,et al.Intensive insulin therapy in the medical ICU. N Engl J Med, 2006,354:449-461.
2. Author L,S Finfer S.Intensive versus conventional glucose control in critically ill patients.N Engl J Med,2009;360:1283-1297.
3. 張久之,萬獻堯,吳向東.急性腦血管病機械通氣患者院內死亡的預后因素分析.中國呼吸與危重監護雜志,2008,7:281-285.
4. Critchell CD,Savarese V,Callahan A,et al.Accuracy of bedside capillary blood glucose measurements in critically ill patients.Intensive Care Med,2007,33:2079-2084.
5. Cottingham CA.Resuscitation of traumatic shock: a hemodynamic review. AACN Adv Crit Care,2006,17:317-326.
6. Van den Berghe G.How does blood glucose control with insulin save lives in intensive care? J Clin Invest,2004,114:1187-1195.
7. Coursin DB,Connery LE,Ketzler JT. Perioperative diabetic and hyperglycemic management issues.Crit Care Med,2004,32:S116-S125.
8. Finkielman JD,Oyen LJ,Afessa B,et al. Agreement Between Bedside Blood and Plasma Glucose Measurement in the ICU Setting.Chest,2005,127:1749-1751.
9. Desachy A,Vuagnat AC,Ghazali AD,et al. Accuracy of Bedside Glucometry in Critically Ill Patients: Influence of Clinical Characteristics and Perfusion Index.Mayo Clin Proc,2008,83:400-405.
10. Van den Berghe G,Wouters P,Weekers F,et al.Intensive insulin therapy in critically ill patients.N Engl J Med,2001,345:1359-1367.
11. 謝平初,陸家齊,孫大銘,等.豬內毒素休克外周與內臟微循環灌注的動態變化.中國危重病急救醫學,1999,11:718-720.
12. 季大璽,謝紅浪,黎磊石.連續性血液凈化與非腎臟疾病.中國危重病急救醫學,2001,13:5-9.
13. Read JL,Cheng EY.Intensive insulin therapy for acute hyperglycemia. AACN Adv Crit Care,2007,18:200-212.
14. Harper J,Glucose control in the intensive care unit: how it is done. Proc Nutr Soc,2007,66:362-366.

Chinese Journal of Respiratory and Critical Care Medicine

危重患者持續靜靜脈血液濾過時血糖監測的影響因素研究

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