• 南京大學醫(yī)學院附屬鼓樓醫(yī)院ICU（江蘇南京 210008）通訊作者: 顧勤, E-mail: ICUGuQin@ yahoo. com. cn;

目的 觀察危重患者持續(xù)靜靜脈血液濾過( CVVH) 過程中血糖監(jiān)測的影響因素。方法 選擇CVVH治療的危重患者30 例, 根據(jù)其入選時的循環(huán)狀態(tài)將患者分為休克組和非休克組, 同時監(jiān)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(jiān)測值。結(jié)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(tǒng)計學意義( P  gt; 0. 05) , 且二者存在明顯相關(guān)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(tǒng)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(tǒng)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(tǒng)計學意義( P  gt;0. 05) 。結(jié)論 危重患者末梢血糖監(jiān)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(jiān)測血糖。

引用本文： 虞竹溪,顧勤,劉寧,楊樸強. 危重患者持續(xù)靜靜脈血液濾過時血糖監(jiān)測的影響因素研究. 中國呼吸與危重監(jiān)護雜志, 2010, 9(1): 85-87. doi: 復制

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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(nèi)死亡的預后因素分析.中國呼吸與危重監(jiān)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(nèi)毒素休克外周與內(nèi)臟微循環(huán)灌注的動態(tài)變化.中國危重病急救醫(yī)學,1999,11:718-720.
12. 季大璽,謝紅浪,黎磊石.連續(xù)性血液凈化與非腎臟疾病.中國危重病急救醫(yī)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. 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. 2. Author L,S Finfer S.Intensive versus conventional glucose control in critically ill patients.N Engl J Med,2009;360:1283-1297.
  3. 3. 張久之,萬獻堯,吳向東.急性腦血管病機械通氣患者院內(nèi)死亡的預后因素分析.中國呼吸與危重監(jiān)護雜志,2008,7:281-285.
  4. 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. 5. Cottingham CA.Resuscitation of traumatic shock: a hemodynamic review. AACN Adv Crit Care,2006,17:317-326.
  6. 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. 7. Coursin DB,Connery LE,Ketzler JT. Perioperative diabetic and hyperglycemic management issues.Crit Care Med,2004,32:S116-S125.
  8. 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. 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. 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. 11. 謝平初,陸家齊,孫大銘,等.豬內(nèi)毒素休克外周與內(nèi)臟微循環(huán)灌注的動態(tài)變化.中國危重病急救醫(yī)學,1999,11:718-720.
  12. 12. 季大璽,謝紅浪,黎磊石.連續(xù)性血液凈化與非腎臟疾病.中國危重病急救醫(yī)學,2001,13:5-9.
  13. 13. Read JL,Cheng EY.Intensive insulin therapy for acute hyperglycemia. AACN Adv Crit Care,2007,18:200-212.
  14. 14. Harper J,Glucose control in the intensive care unit: how it is done. Proc Nutr Soc,2007,66:362-366.