Related factors of blood glucose values in ICU
-
摘要:
目的 比较ICU危重症患者动脉血气血糖和末梢血糖值的可靠性;分析影响动脉血气血糖值和末梢血糖值之间差异的相关因素。 方法 选取ICU重症患者40例,晨间同时检测患者动脉血气和快速末梢血糖。 结果 动脉血气分析和快速末梢血糖检测的血糖值与静脉血生化中的血糖值均高度相关(r=0.952,P<0.01)。动脉血气血糖和末梢血糖之前存在差异,具有统计学意义(P<0.05)。动脉血气血糖和末梢之间的差异受末梢循环的影响。 结论 危重症患者采用末梢血糖测量结果作为控制血糖策略的可靠性还有待进一步研究,末梢血糖测量结果受末梢循环的影响。 Abstract:Objective To compare the reliability of arterial blood gas, blood glucose and peripheral blood glucose in critically ill patients with ICU, and analyze the related factors of variation of glucose values of the two measurement. Methods Fourty ICU critical patients were selected.In the morning, two kinds of blood samples, i.e.arterial blood and capillary blood, were collected and tested at the same time. Results Arterial blood glucose and capillary blood glucose showed a strong correlation with venous blood glucose (r=0.952, P<0.001).The mean difference (bias) was significant (P<0.005) for arterial blood glucose and venous blood glucose.The diffence blood glucose values of two blood glucose measurement was influenced by the status of peripheral circulation of finger tips. Conclusion Reliablity of the blood glucose values of capillary blood need further study in critical patients.the status of peripheral circulation of finger tips is one influencing factor of capillary blood values. -
Key words:
- critical patients /
- arterial blood glucose /
- capillary blood glucose
-
表 1 脉血糖值和末梢血糖值差异的相关因素分析
模型 非标准化系数 标准系数 t P B 标准误差 试用版 常量 -0.823 9.485 -0.087 0.932 T -0.021 0.224 -0.019 -0.092 0.928 LAC 0.403 0.221 0.392 1.823 0.086 SAO2 0.011 0.030 0.084 0.376 0.712 末梢循环 -0.665 0.306 -0.440 -2.173 0.044* *P<0.05. -
[1] Le HT, Harris NS, Estilong AJ, et al. Blood glucose measurement in the intensive care unit: what is the best method[J]. J Diabetes Sci Technol, 2013, 7(2): 489-99. doi: 10.1177/193229681300700226 [2] Kanji S, Buffie J, Hutton B, et al. Reliability of point-of-care testing for glucose measurement in critically ill adults[J]. Crit Care Med, 2005, 33(12): 2778-85. doi: 10.1097/01.CCM.0000189939.10881.60 [3] Pulzi SA, Assunção MS, Mazza BF, et al. Accuracy of different methods for blood glucose measurement in critically ill patients[J]. Sao Paulo Med J, 2009, 127(5): 259-65. doi: 10.1590/S1516-31802009000500003 [4] 唐 健, 顾 勤. 危重患者早期血糖波动与预后的相关性研究[J]. 中国危重病急救医学, 2012, 24(1): 50-3. http://www.cnki.com.cn/Article/CJFDTOTAL-YCGC201405001.htm [5] Richards JE, Kauffmann RM, Obremskey WT, et al. Stress-induced hyperglycemia as a risk factor for surgical-site infection in nondiabetic orthopedic trauma patients admitted to the intensive care unit[J]. J Orthop Trauma, 2013, 27(1): 16-21. doi: 10.1097/BOT.0b013e31825d60e5 [6] Fekih HM, Ayed S, Gharbi R, et al. Bedside capillary blood glucose measurements in critically ill patients: influence of catecholamine therapy[J]. Diabetes Res Clin Pract, 2010, 87(1): 87-91. doi: 10.1016/j.diabres.2009.09.018 [7] Binette TM, Cembrowski GS. Diverse influences on blood glucose measurements in the ICU setting[J]. Chest, 2005, 128(4): 3084-5. [8] Inoue S, Egi M, Kotani J, et al. Accuracy of blood-glucose measurements using glucose meters and arterial blood gas analyzers in critically ill adult patients: systematic review[J]. Crit Care, 2013, 17(2): R48-52. doi: 10.1186/cc12567 [9] Herpet V, tend M. Blood glucose measurements incritically ill patients[J]. J Diabetes Sci Technol, 2012, 6(1): 22-8. doi: 10.1177/193229681200600104 [10] Stork AD, Kemperman H, Erkelens DW, et al. Comparison of the accuracy of the HemoCue glucose analyzer with the Yellow Springs Instrument glucose oxidase analyzer, particularly in hypoglycemia[J]. Eur J Endocrinol, 2005, 153(2): 275-81. doi: 10.1530/eje.1.01952 [11] Heinemann L, Lodwig V, Freckmann G. Accuracy in blood glucose measurement: what will a tightening of requirements yield?[J]. J Diabetes Sci Technol, 2012, 6(2): 435-43. doi: 10.1177/193229681200600232 [12] Krinsley J, Bochicchio K, Calentine C, et al. Glucose measurement of intensive care unit patient plasma samples using a fixed-wavelength mid-infrared spectroscopy system[J]. J Diabetes Sci Technol, 2012, 6(2): 294-301. doi: 10.1177/193229681200600212 [13] Nerhus K, Rustad P, Sandberg S. Effect of ambient temperature on analytical performance of self-monitoring blood glucose systems[J]. Diabetes Technol Ther, 2011, 13(9): 883-92. doi: 10.1089/dia.2010.0255 [14] Fahy BG, Coursin DB. Critical glucose control: the devil is in the details[J]. Mayo Clin Proc, 2008, 83(4): 394-7. doi: 10.4065/83.4.394 [15] Bénéteau-Burnat B, Bocque MC, Lorin A, et al. Evaluation of the blood gas analyzer Gem PREMIER 3000[J]. Clin Chem Lab Med, 2004, 42(1): 96-101. [16] 庞双艳, 许 航, 张万江, 等. ICU危重患者两种血糖检测结果可靠性的比较[J]. 实用医院临床杂志, 2015, 12(4): 115-8. http://www.cnki.com.cn/Article/CJFDTOTAL-YYLC201504043.htm [17] 虞竹溪, 顾 勤, 刘 宁, 等. 危重患者持续静静脉血液滤过时血糖监测的影响因素研究[J]. 中国呼吸与危重监护杂志, 2010, 9(1): 85-7. http://www.cnki.com.cn/Article/CJFDTOTAL-ZGHW201001028.htm [18] Karon BS, Griesmann L, Scott R, et al. Evaluation of the impact of hematocrit and other interference on the accuracy of hospital-based glucose meters[J]. Diabetes Technol Ther, 2008, 10(2): 111-20. doi: 10.1089/dia.2007.0257 [19] Malone B. Blood glucose meters: is FDA ready to tighten up accuracy standards[EB/OL]. Clinic Laborat News, 2010, 36(5): 67-70. [20] Jacobi J, Bircher N, Krinsley J, et al. Guidelines for the use of an insulin infusion for the management of hyperglycemia in critically ill patients[J]. Crit Care Med, 2012, 40(12): 3251-76. doi: 10.1097/CCM.0b013e3182653269