基于波特兰草案构建以护士为主导的危重患者血糖管理模式的应用

Application of nurse-led blood glucose management model for critically ill patients based on Portland draft

目的观察基于波特兰草案构建以护士为主导的血糖管理模式应用于危重患者中的临床价值。方法选取2019年7月-2020年12月我院收治的35例危重患者设为对照组;选取2021年1月-2022年6月我院收治的35例危重患者设为观察组。对照组接受常规血糖管理,观察组在对照组的基础上接受基于波特兰草案构建以护士为主导的血糖管理模式。比较两组干预前后血糖水平、血糖控制情况[治疗期间血糖水平、血糖波动幅度(MAGE)、血糖达标时间]及胰岛素每日用量;比较血糖控制稳定性指标[平均血糖值(Ave)、血糖变异率(CV)、血糖值标准差(SD)及血糖不稳定指数(GLI)]及干预后低血糖发生率。结果两组干预后血糖水平均显著下降(P<0.05);但两组干预前后血糖水平比较差异无统计学意义(P>0.05);观察组MAGE低于对照组,血糖达标时间短于对照组,胰岛素每日用量少于对照组(P<0.05);观察组Ave、CV、血糖SD、GLI均低于对照组(P<0.05);观察组干预后低血糖发生率低于对照组(P<0.05)。结论基于波特兰草案构建以护士为主导的血糖管理模式应用于危重患者中,能够有效控制患者血糖水平,减少血糖波动性,降低低血糖发生风险。

Objective To observe the clinical value of the application of nurse-led blood glucose management model on critically ill patientsbased on the Portland draft.Methods 35 critically ill patients admitted to the Second Affiliated Hospital of Nanchang University from July 2019 to December 2020 were selected as the control group;35 critically ill patients admitted to our hospital from January 2021 to June 2022 were selected as the control group.For the observation group,both patients in two groups received conventional treatment after admission,and the control group received conventional blood glucose management.On this basis,the patients in the observation group received a nurse-led blood glucose management model based on the Portland draft.Observe and compare the blood glucose before and after intervention in two groups.Compare the blood glucose control conditions in two groups including blood glucose level during treatment,blood glucose fluctuation range(MAGE),blood glucose reaching the target time.Investigate the stability of blood glucose control includingthe average blood glucose(AVE),rate(CV),standard deviation of blood glucose value(SD)and glycemic instability index(GLI).The incidence of hypoglycemia and infection after intervention in the two groups were recorded and compared.Results After the intervention,the blood glucose levels of the two groups significantly decreased,and there was a statistical difference(P<0.05);but there was no statistical difference before and after the intervention in twogroups(P>0.05).The MAGE of the observation group was lower than that of the control group,the blood glucose reaching time was shorter than that of the control group,and the daily dosage of insulin was less than that of the control group,with statistical differences(P<0.05).The incidence of hypoglycemia in the observation group was lower than in the control group,with a statistical difference(P<0.05).Conclusion The nurse-led blood glucose management model construction based on the Portland draft can be used in critically ill patients,which can effectively control the blood glucose level,reduce blood glucose fluctuation,and reduce the risk of hypoglycemia.