即時連續性血糖監測在患有糖尿病母親的早產兒臨床使用之價值

為了確定在重症加護病房使用即時連續血糖值監測系統 (RTGMS) 的可行性, 我們的研究重點是使用即時連續血糖值監測系統在患有糖尿病母親的早產兒, 因為他們比較容易發生血糖異常情形。一共有三十位早產兒 (糖尿病母親= 15 和非糖尿病母親 = 15; 懷孕週數≦36週) 是在出生後72小時內進行的研究。這些嬰兒出生後住進新生兒重症加護病房, 並根據他們的母親是否患有糖尿病而進一步歸類為兩小組。病人的血糖值是同時使用即時連續性血糖值監測系統(RTGMS) 和傳統的間歇性動脈血血糖值來監測。此研究的結果發現30位早產兒對即時連續葡萄糖監測耐受性良好。即時連續性血糖值監測系統和傳統的間歇性動脈血血糖值測定有良好的一致性。在這些早產兒中, 以即時連續性血糖值監測的血糖值中發現在間歇性動脈血血糖測量的檢查點間隔間有33.33%, 發生了異常的血糖值 (低血糖或高血糖)。使用即時連續血糖值監測的優點是它可以減輕被采血時的疼痛, 更病人以更舒適的方式獲得資訊, 能即時提供血糖資訊以及對血糖異常有高靈敏度 (94.59%) 和特異性 (97.87%), 特別是使用在患有血糖變異較高的糖尿病母親的早產兒。即時連續性血糖值監測可以監測到使用傳統間歇性動脈血血糖值測定方式所無法監測到的早產兒血糖波動。即時連續性血糖值監測比間歇性血糖測可以測定出更多的異常血糖濃度。高危險群的嬰兒, 尤其是患有糖尿病母親的早產兒, 更應該要使用即時連續性血糖值監測來監測血糖值, 以獲得更密集及精準的血糖波動及變化。

關鍵字

糖尿病母親的早產兒；即時連續性血糖監測

並列摘要

To determine the feasibility of using a real-time continuous glucose monitoring system (RTGMS) in intensive care units, our study focus on preterm infants with diabetic mothers owing to their high risk of blood sugar abnormalities. Thirty preterm babies (M = 15 and F =15; ≦ 36 week gestation age) were studied from within 72 hours of delivery. These babies were admitted to the newborn intensive care and were further categorized into groups based on whether their mothers with or without diabetic mellitus. Blood sugar levels were monitored by both RTGMS and the traditional intermittent arterial line (A-Line) glucose method. Continuous glucose monitoring were well tolerated in 30 infants. There were good consistency between RTGMS and A-Line glucose concentration measurements. Of the preterm infants, 33.33% experienced abnormal glucose levels (hypoglycemia or hyperglycemia) between the checkpoint intervals of the intermittent A-Line blood sugar measurements. RTGM showed advantages with regards to reduced pain, greater comfort, the provision of real-time information, high sensitivity (94.59%) and specificity (97.87%) in discovering abnormalities of blood sugar, which are especially valuable for premature infants of diabetic mothers. RTGMS is comparable to A-line measurement for identifying fluctuations in blood glucose in premature infants. RTGMS detects more episodes of abnormal glucose concentration than intermittent A-line blood glucose measurement. High risk infants, especially premature infants with diabetic mothers, should receive more intensive blood sugar level checks by using continuous RTGMS.

並列關鍵字

real-time continuous glucose monitoring ； premature infants of diabetic mothers

參考文獻

1. Stensvold HJ, Strommen K, Lang AM, Abrahamsen TG, Steen EK, Pripp AH, et al.Early Enhanced Parenteral Nutrition, Hyperglycemia, and Death Among Extremely- Low- Birth- Weight Infants. JAMA Pediatr. 2015; 169(11):1003±10.

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