团队模式信息化院内血糖联网监测和标准化血糖管理对外科重症监护室患者血糖控制情况的影响

The effect of team model of in-patient glucose management combined with internet-based glucose monitoring system on blood glucose control in SICU patients

目的研究团队模式信息化院内血糖联网监测和标准化血糖管理对外科重症监护室(ICU)住院患者血糖控制情况的影响。方法选取2018年7月1日至11月30日入住我院外科重症监护室的患者411例为团队模式联合信息化血糖管理组(IBGMS模式组),采用由糖尿病专科医生和护士团队,根据网络信息化血糖数据,主动进行标准化血糖管理的模式;2017年7月1日至11月30日入院的外科重症监护室的患者785例为常规会诊模式血糖管理组(常规模式组),采用由对方科室根据患者病情发送会诊需求,我科提供会诊服务的常规血糖管理模式。比较两种不同血糖管理模式的差异。结果IBGMS模式组的高血糖检出率、严重高血糖检出率、目标血糖达标率高于常规模式组,低血糖检出率及临床显著低血糖检出率低于常规模式组(P<0.05)。IBGMS模式组的血糖漂移度、最大血糖波动幅度均明显降低,平均血糖监测次数更多,糖化血红蛋白检测率更高,平均住院日更短,差异均有统计学意义(P<0.05)。结论团队模式信息化院内血糖联网监测和标准化血糖管理提高了外科重症监护室异常血糖的检出率及平均血糖监测次数,降低了低血糖的发生,有效改善了外科重症监护室住院患者血糖波动幅度及血糖控制情况。

Objective To investigate the influence of the team model of in-patient glucose management(IPGM)combined with internet-based glucose monitoring system(IBGMS)on the blood glucose control of patients in surgical intensive care unit(SICU).Methods We selected 411 patients who stayed in SICU of our hospital from July 1,2018 to November 30,2018 as IBGMS model group.For the IBGMS group,a team of diabetic specialists and nurses actively performed standardized blood glucose management according to information of IBGMS.From July 1,2017 to November 30,2017,785 patients admitted to SICU were used as routine model group.For the routine model group,our department provided consultation service for routine blood glucose management when other department sent consultation needs according to the patient's condition.The differences between the two models were compared.Results The detection rate of hyperglycemia,severe hyperglycemia and hypoglycemia were higher and the detection rate of clinical significant hypoglycemia and target blood glucose level was lower in the IBGMS model group than those in the routine model group.In the IBGMS model group,the blood sugar drift and the maximum blood sugar fluctuation were significantly reduced.The average blood glucose monitoring times in the IBGMS model group were more than those in the conventional model group,the detection rate of glycosylated hemoglobin was higher,and the average hospitalization day was shorter(P<0.05).Conclusion The blood glucose management in the team model and the standardized blood glucose management in the SICU improve the detection rate of abnormal blood glucose and the average blood glucose monitoring times,and reduce the incidence of hypoglycemia.The fluctuation amplitude of blood glucose and the blood glucose control of patients in the SICU are effectively improved.