Aims: To evaluate the effectiveness of a tailored blood glucose control protocol for postoperative cardiac surgery patients treated in intensive care.
Design: Retrospective study.
Methods: Data for the control group (non-tailored protocol) were collected from medical records at a tertiary hospital in Seoul, Korea between April-July 2015. Data for the experimental group (tailored protocol) were obtained from medical records between April-July 2016. After adjusting the target blood glucose range, eliminating single-dose insulin administration and extending the blood glucose measurement time interval, data for blood glucose measurements, time for reaching and maintaining target blood glucose, mean number of daily blood glucose measurements and insulin dose adjustments for the experimental group were collected.
Results: In the experimental group (where the target blood glucose rate was increased) the hypoglycaemia rate and the variation in blood glucose decreased significantly compared with the control group. In particular, the experimental group maintained relatively stable blood glucose levels by retaining a small variation range in glucose, regardless of the presence of diabetes. Time required for maintaining target blood glucose, mean number of daily blood glucose measurements and insulin dose adjustments per patient decreased.
Conclusion: The tailored protocol contributes to the safe and effective control of blood glucose in critical care patients after cardiac surgery and to the efficiency of nurses administering it.
Impact: This study has two significant impacts. The application of the tailored protocol has a positive impact on patients' blood glucose management, a critical component of treatment for postoperative cardiac patients in intensive care units. It also has a positive impact on the efficiency of nurses applying it. The results of this study are thus expected to facilitate successful implementation of clinical protocols for critical care after heart surgery.
目标: 评价重症监护室中心脏手术患者术后进行血糖控制方案的效果。 设计: 回顾性研究。 方法: 对照组数据(非定制方案)收集自2015年4月至7月韩国首尔某三级医院的医疗记录。实验组数据(定制方案)收集自2016年4月至7月的医疗记录。在调整目标血糖范围、取消单剂量胰岛素注射和延长血糖测量时间间隔、血糖测量数据、达到和维持目标血糖的时间后,收集实验组的平均每日血糖测量值和胰岛素剂量调整数。 结果: 与对照组相比,实验组(目标血糖率升高)的低血糖率和血糖变化率显著降低。特别是,实验组的血糖水平保持在相对稳定的水平,不管其中的患者是否患有糖尿病。维持目标血糖所需的时间、平均每日血糖测量次数和每位患者胰岛素剂量调整减少。 结论: 该方案有助于安全有效地控制心脏手术后危重患者的血糖,提高护士的管理效率。 影响: 这项研究具有两大重要影响。该定制方案的应用对患者血糖管理具有积极的影响作用,其实重症监护病房心脏术后患者治疗的重要组成部分。此外,对于护士对于该方案的应用效率也有着积极的影响。因此,本研究的结果将有助于心脏手术后危重症护理临床方案的成功实施。.
Keywords: blood glucose; clinical protocols; intensive care units; nurses.
© 2020 John Wiley & Sons Ltd.