ISSN 2096-7446　CN 10-1655/R
主管：中国科学技术协会
主办：中华护理学会
中华急危重症护理杂志

中华急危重症护理杂志 ›› 2024, Vol. 5 ›› Issue (2): 101-107.doi: 10.3761/j.issn.2096-7446.2024.02.001

• 论著 •    下一篇

成人危重症患者血糖管理现状及护理实践内容的田野研究

黄苗 甘秀妮 张传来 周雯   

  • 出版日期:2024-02-10 发布日期:2024-02-20

A field study of the status and contents of nursing practice in the management of blood glucose in critically ill adults

HUANG Miao，GAN Xiuni，ZHANG Chuanlai，ZHOU Wen   

  • Online:2024-02-10 Published:2024-02-20

摘要： 目的 了解当前我国成人危重症患者血糖管理现状及护理实践内容，明确实践过程中存在的问题并给出改进建议。 方法 2021年9月-2022年4月，采用田野研究方法对重庆市4所三级甲等医院ICU血糖管理实践进行了为期8个月的非参与式观察。 采用ICU患者血糖管理情况表及护理人员血糖管理实践记录表收集量性资料，反复阅读田野笔记，汇总现有护理实践内容、当前血糖管理护理实践中存在的问题，进一步进行资料归类及深入分析。 结果 4所田野观察地均拥有纸质版胰岛素输注方案，方案平均使用时间为（9.00±2.92）年， 但方案内容存在差异；共观察60例高血糖患者，不同田野地的患者在入住ICU期间的高血糖持续时间、达到目标血糖水平所需时间及目标血糖范围的维持时间差异无统计学意义。 12名护士血糖管理主要工作内容包括胰岛素输注及调整、血糖监测、患者营养管理、低血糖处理，但在血糖监测方式、胰岛素使用方式、营养支持是否伴随胰岛素输注等问题上仍与最佳证据存在差距。 结论 护理人员需在提升自我临床决策能力的基础上，构建并实施基于最佳证据的全面、规范且统一的成人危重症患者血糖管理实践方案，这是解决当前田野地血糖管理实践问题的主要策略。

关键词: 危重病, 血糖管理, 胰岛素输注系统, 护理实践, 田野研究

Abstract: Objective To understand the status and contents of current nursing practice in the management of blood glucose in critically ill adult patients in China. Methods From September 2021 to April 2022，an 8-month non-participatory observation of glucose management practice in the intensive care units of four tertiary care hospitals in Chongqing was conducted using field research. Quantitative data were collected using the ICU patient glucose management profile form and nursing staff glucose management practice record form. We repeatedly read the field notes and summarized existing nursing practices and existing problems in current blood glucose management nursing practices，further categorized and conducted in-depth analysis of the data. Results All four field observation sites had paper-based insulin infusion protocols，and the mean duration of the use of the protocols was（9±2.92） years，and the contents of the protocols differed across the fields. A total of 60 hyperglycemic patients were observed，and there were no statistically significant differences in the duration of hyperglycemia，the time required to reach target blood glucose level，and the maintenance of the target blood glucose range among patients from different field sites. The main tasks of the 12 nurses in glucose management included insulin infusion and adjustment，glucose monitoring，patient nutrition management，and hypoglycemia treatment. However，there was still a gap with the best evidence on blood glucose monitoring method，insulin use，whether nutritional support should be combined with insulin infusion，etc. Conclusion Nursing staff need to enhance their clinical decision-making skills，and further construct and implement a comprehensive and standardized practice plan for glucose management in critically ill adult patients based on the best evidence. This is a main solution to address current glucose management practice issues in the field sites.

Key words: Critical Illness, Glucose Management, Insulin Infusion System, Nursing Practice, Field Research