2012重症医学顶级杂志AIC发表研究报道——血糖控制时不同输液管路可能是重要的危险因

蓝鱼o_0

Continuous insulin administration via complex central venous catheter infusion tubing is another risk factor for blood glucose imbalance. A retrospective study

Eric Maury, Paola Vitry, Arnaud Galbois, Hafid Ait-Oufella, Jean-Luc Baudel, Bertrand Guidet and Georges Offenstadt

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Annals of Intensive Care 2012, 2:16 doi:10.1186/2110-5820-2-16

这个杂志，ICU医生应该不陌生吧，15分以上。重症医学中的顶级杂志。
Published: 14 June 2012 Abstract (provisional)Background

We assessed the potential impact of infusion tubing on blood glucose imbalance in ICU patients given intensive insulin therapy (IIT). We compared the incidence of blood glucose imbalance in patients equipped, in a nonrandomized fashion, with either conventional tubing or with a multiport infusion device.

Methods

We retrospectively analyzed the nursing files of 35 patients given IIT through the distal line of a double-lumen central venous catheter. A total of 1389 hours of IIT were analyzed for occurrence of hypoglycemic events [defined as arterial blood glucose below 90 mg/dL requiring discontinuation of insulin].

Results

Twenty-one hypoglycemic events were noted (density of incidence 15 for 1000 hours of ITT). In 17 of these 21 events (81%), medication had been administered during the previous hour through the line connected to the distal lumen of the catheter. Conventional tubing use was associated with a higher density of incidence of hypoglycemic events than multiport infusion device use (23 vs. 2 for 1,000 hours of IIT; rate ratio = 11.5; 95% confidence interval, 2.71-48.8; p < 0.001).

Conclusions

The administration of on-demand medication through tubing carrying other medications can lead to the delivery of significant amounts of unscheduled products. Hypoglycaemia observed during IIT could be related to this phenomenon. The use of a multiport infusion device with a limited dead volume could limit hypoglycemia in patients on IIT.

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蓝鱼o_0

为了便于大家理解，我把图截取出来给大家看。

那么为什么复杂的管路容易造成低血糖呢？

当然是相对于三通管来说。

蓝鱼o_0

可以发现传统的复杂管路，在血糖控制时是低血糖症的重要危险因素。RR： 11.5， 95%CI=2.71-48.8， P=0.001.

蓝鱼o_0

大家也许有疑问：既然是retrospectively  study， 那么RR是怎么算出来的呢？
这里要纠正一个错误观念，回顾性的研究只是时间结点是在过去到现在或者到将来。
如果是从暴露到结局的话，是能够计算RR的。或者说，这也是验证暴露强度的重要方法，并且相对于CC（CASE-CONTROL ）他的强度更强。

蓝鱼o_0

蓝鱼o_0 发表于 2012-6-23 23:15

                               
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为了便于大家理解，我把图截取出来给大家看。

那么为什么复杂的管路容易造成低血糖呢？

【答案揭秘】回复2楼：为什么三通管相对于传统complex tubing反而不容易导致低血糖呢？

文中给出的解释是这样的：
The use of a multiport infusion device with a limited dead space is associated with a lower incidence of hypoglycemic events. This is probably related to the fact that flushing of the tube contents is avoided with the multiport infusion device。
这是作者对于现象的一个推测，看到这段话大家还是理解不了。
我来解释一下：
三通管的好处就是limited dead space,死腔少。在二楼的图中，我们可以看到，对于complex tubing，他里面有些输液死腔。在拐角处和其他输液段。即相对于三通管来说，死腔多。那么导致的直接问题是，在进行管路冲洗时候，用生理盐水或者冲洗液未必能有效清除残留胰岛素。继而变相变成了“胰岛素缓释剂”。从而导致低血糖症。

细菌耐药

非常精彩，学习了，谢谢蓝鱼超版的分享！

宫圆圆

学习了，谢谢蓝分享