ICU成人患者血糖监测及多维度管理的最佳证据转化及效果评价

doi:10.3761/j.issn.2096-7446.2025.12.001

摘要/Abstract

摘要：

目的以复旦大学循证护理中心证据临床转化模式为指导，将ICU成人危重症患者血糖管理最佳证据应用于临床实践并评价其应用效果。方法通过证据获取、基线审查、实践变革和效果评价4个阶段，将最佳证据应用于浙江省某三级甲等医院急诊ICU成人危重症患者。比较基线审查（2024年6月—7月）和循证实践后（2024年10月—11月）医护人员审查指标执行率、患者血糖目标范围时间比例、血糖变异度及低血糖发生例数。结果共纳入医生8名，护士28名，循证实践前后各纳入患者30例，与基线审查时比较，循证实践后实践者层面审查指标执行率均提高，其中12条审查指标循证实践前后比较差异有统计学意义（P<0.05），系统层面一次性审查指标（指标10、24）执行率由循证实践前的0提升至100%；循证实践前后患者平均血糖目标范围时间比例、血糖变异度比较，差异有统计学意义（P=0.026、0.027）；低血糖发生例数差异无统计学意义（P=0.667）。结论血糖管理循证实践可有效规范医护人员的诊疗、护理行为，提高ICU成人危重症患者血糖目标范围时间比例，降低血糖变异度及低血糖发生例数。

关键词: 重症监护病房, 血糖控制, 循证实践

Abstract:

Objective Guided by the Evidence Implementation Model developed by the Fudan University Centre for Evidence-Based Nursing，this study aimed to apply the best evidence for glycemic management in critically ill patients and evaluate its effectiveness. Methods A four-phase approach—comprising evidence retrieval，baseline audit，practice innovation，and outcome evaluation—was employed to implement best practice in glycemic management in the ICU of a tertiary class A hospital in Zhejiang Province. Outcomes were compared before（June-July 2024） and after（October-November 2024） the evidence application，focusing on healthcare providers’ compliance with audit criteria，the proportion of patients within the time in target blood glucose range，glucose variability，and the incidence of hypoglycemia. Results The study included 8 physicians，28 nurses，and 60 patients（30 before and 30 after the intervention）. After the evidence practice，there was a significant improvement in the execution rates of audit criteria among clinicians，with 12 audit indicators showing statistically significant differences compared to baseline（P<0.05）. System-level audit criteria（items 10，24） achieved 100% compliance. The differences in the average proportion of patients within the time in target blood glucose range and glucose variability before and after the evidence-based practice were statistically significant（P=0.026，0.027）. However，the difference in the incidence of hypoglycemia was not statistically significant（P=0.667）. Conclusion The evidence-based practice for blood glucose management effectively standardized the behaviors of healthcare providers，improved the proportion of critically ill patients within the target blood glucose range，reduced glucose variability and the incidence of hypoglycemia.

Key words: Intensive Care Units, Glycemic Control, Evidence-based Practice

杨慧杰, 何佳涛, 黄赣英. ICU成人患者血糖监测及多维度管理的最佳证据转化及效果评价[J]. 中华急危重症护理杂志, 2025, 6(12): 1413-1420.

YANG Huijie, HE Jiatao, HUANG Ganying. Evidence transformation and effect evaluation of glycemic monitoring and multidimensional management in adult ICU patients[J]. Chinese Journal of Emergency and Critical Care Nursing, 2025, 6(12): 1413-1420.

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