病歷回溯法比較重症病人不同血糖控制法血糖控制之成效－以某醫學中心加護病房為例

The Effectiveness of Glycemic Control with Different Methods in Critically Ill Patients-Retrospective Study: Experience of a Medical Center in the Intensive Care Unit

王如慧(Ju-Huei Wang) ； 呂玉珍(Yu-Chen Lu) ； 顧艷秋(Yan-Choiu Ku) ； 張惠敏(Hui-Min Chang)

《榮總護理》 32卷1期 (2015/03) Pp. 65-73

https://doi.org/10.6142/VGHN.32.1.65

摘要

重症病人常因血糖控制不穩而影響病況，欲控制病人血糖小於150 mg/dl，故單位使用神經網路血糖控制法來控制血糖。本研究的目的為比較使用神經網路血糖控制法與非神經網路血糖控制法兩者間血糖值異常率之差異，以作為血糖控制方法的選擇。採病例對照研究設計，收集時間從2010年1月到2011年1月的電子病歷查閱，研究對象為急診加護病房和內科加護病房重症病人，各35位病人，共收集6天病人飯前及飯後血糖值＞150 mg/dl之不正常比率與發生低血糖之比率。結果顯示：1.神經網路組比非神經網路組在第六天其飯前血糖異常率有顯著上的差異（p=.032）。2.飯後血糖雖沒有顯著差異，但在第六天非神經網路組血糖值異常率並無降低；而神經網路組血糖值異常率卻下降22%。神經網路組較能控制病人血糖在理想的血糖值，建議相同性質的加護病房可採用神經網路血糖控制法，期能有效控制病人血糖、減少病人在監測血糖抽血及注射胰島素的疼痛感。

關鍵字

加護病房 ； 重症病人 ； 神經網路血糖控制

並列摘要

Unstable blood sugar control typically affects the condition of critically ill patients. To maintain the blood sugar of critically ill patients' at less than 150 mg/dl, we used the＂ Neuro-fuzzy＂ method. We also compared the differences in blood sugar control between the Neuro-fuzzy method and other methods in critically ill patients to fine a reference for controlling blood sugar. A case control study design, data on critically ill patients who stayed in EMCU and MICU were collected from January 2010 to January 2011. A total of 35 patients had an irregular blood sugar level and low blood sugar level, according to data measured before and after meals in the first 6 days. The study revealed some crucial findings: 1. The patient group that received the Neuro-fuzzy method exhibited significant differences in the irregular blood sugar level on Day 6 (p=.32). 2. Although the blood sugar level measured after meals did not differ, the irregular blood sugar level of the patients who received other methods did not decrease on Day 6. By contrast, the irregular blood sugar level of the patients who received the Neuro-fuzzy method decreased by 22% on Day 6. Applying the Neurofuzzy method can control patients' blood sugar within a controllable range. This study indicated that the Neuro-fuzzy method for controlling patients' blood sugar could be applied for other ICUs with similar functions. The Neur-fuzzy method for controlling patients' blood sugar can also reduce the nursing effort, cost, and frequency of measuring blood sugar, as well as patients' pain during insulin injection.

並列關鍵字

intensive care unit ； critically ill patients ； Neur-fuzzy method