重症患者第一滴和第二滴指尖血血糖值的差异分析(1)
[摘要]目的 探讨重症患者血糖监测中使用第一滴和第二滴指尖血的差异，为临床操作提供参考依据。方法 随机选取2016年9～11月在重庆医科大学附属永川医院入住ICU的30例患者作为研究对象，选择患者的中指或无名指，用温水清洁并干燥待测手指，将该侧手臂自然下垂片刻，再用75%乙醇消毒待干后监测第一滴及第二滴指尖血的血糖值，各收集数据52组，比较重症患者第一滴和第二滴指尖滴血两组患者的数据，并进行统计学分析。结果 重症患者第一滴和第二滴指尖滴血的血糖值比较，差异无统计学意义(P>0.05)。结论 在规范操作的前提下，使用第一滴指尖血进行血糖监测结果与使用第二滴指尖血同样准确，因此建议使用第一滴指尖血，且其有利于简化血糖监测流程、缩短护理操作时间、减少医源性污染、节约医疗耗材、减轻患者的疼痛，值得在临床上推广应用。
[关键词]重症患者；第一滴指尖血；第二滴指尖血；差异
[中图分类号] R587.1 [文献标识码] A [文章编号] 1674-4721(2017)11(b)-0043-03
[Abstract]Objective To analyze the difference between using the first and the second drop of blood in blood glucose monitoring of critically ill patients，and to provide clinical practice for information.Methods The 30 patients who were admitted to ICU in yongchuan hospital affiliated with chongqing medical university from September to November 2016 were selected randomly as subjects.Patients′ middle or ring fingers were sterilized with 75% alcohol after their ipsilateral arms were hang for a moment，and tested for the blood glucose values through the first and second drop of blood.A total of 52 valid data sets were collected.The data of the two groups of patients with the first and second drop of blood were compared and statistically analyzed.Results There was no significant difference in the blood glucose values between the first and the second drop of blood among critically ill patients (P>0.05).Conclusion In the precondition of normative operation，using the first drop of blood to monitor blood glucose is as accurate as using the second drop of blood，so it is recommended to use the first drop of blood.And it can simplify the blood sugar monitoring process，shorten care operation time，reduce iatrogenic pollution，save medical consumables and reduce patients′ pain，so it is worth of promoting the application in clinic.
[Key words]Critically ill patients；The first drop of blood；The second drop of blood；Difference
重癥患者由于机体处于应激状态，极易发生血糖紊乱，这是增加ICU患者死亡率的独立危险因素，而非糖尿病重症患者的死亡率甚至高于合并糖尿病的患者[1-2]。有报道显示，ICU患者急性高血糖的发生率可达43%～50%，低血糖的发生率为12.59%～26.5%[3-4]。血糖过高或过低均可损害患者的神经细胞和脑细胞，甚至导致死亡。因此，密切监测血糖值，并将其控制在理想范围内，对于改善重症患者的预后有积极作用。
指尖血糖测定是一种通过指端采血来测定血糖值的方法，具有测量结果准确、等待时间短、操作简便、患者出血量少等特点。因此，指尖血糖监测为及时发现危重患者的高血糖、低血糖和了解血糖波动情况带来极大的方便，临床中已得到广泛的应用。在国内外的临床实践中，使用第一滴和第二滴指尖血进行血糖监测的情况都有存在，既往的研究结果也不尽一致。因此，本研究拟通过分析重症患者血糖监测中使用第一滴和第二滴指尖血是否存在差异，为临床操作提供参考，现报道如下。
1资料与方法
1.1一般资料
采用抽签法选取2016年9～11月在重庆医科大学附属永川医院入住ICU的30例患者作为研究对象，男21例，女9例，年龄25～96岁，平均(60.4±16.8)岁，共收集有效数据52组。指尖皮肤有污染、破损、水肿、长茧及凝血功能障碍、严重脱水、采血局部循环差的患者不列入本研究[5-6]。本研究方案经我院医学伦理学委员会批准，取得患者或家属的同意，并签署知情同意书。, http://www.100md.com(程琳芝 丁丽娜 吴晓英)
[关键词]重症患者；第一滴指尖血；第二滴指尖血；差异
[中图分类号] R587.1 [文献标识码] A [文章编号] 1674-4721(2017)11(b)-0043-03
[Abstract]Objective To analyze the difference between using the first and the second drop of blood in blood glucose monitoring of critically ill patients，and to provide clinical practice for information.Methods The 30 patients who were admitted to ICU in yongchuan hospital affiliated with chongqing medical university from September to November 2016 were selected randomly as subjects.Patients′ middle or ring fingers were sterilized with 75% alcohol after their ipsilateral arms were hang for a moment，and tested for the blood glucose values through the first and second drop of blood.A total of 52 valid data sets were collected.The data of the two groups of patients with the first and second drop of blood were compared and statistically analyzed.Results There was no significant difference in the blood glucose values between the first and the second drop of blood among critically ill patients (P>0.05).Conclusion In the precondition of normative operation，using the first drop of blood to monitor blood glucose is as accurate as using the second drop of blood，so it is recommended to use the first drop of blood.And it can simplify the blood sugar monitoring process，shorten care operation time，reduce iatrogenic pollution，save medical consumables and reduce patients′ pain，so it is worth of promoting the application in clinic.
[Key words]Critically ill patients；The first drop of blood；The second drop of blood；Difference
重癥患者由于机体处于应激状态，极易发生血糖紊乱，这是增加ICU患者死亡率的独立危险因素，而非糖尿病重症患者的死亡率甚至高于合并糖尿病的患者[1-2]。有报道显示，ICU患者急性高血糖的发生率可达43%～50%，低血糖的发生率为12.59%～26.5%[3-4]。血糖过高或过低均可损害患者的神经细胞和脑细胞，甚至导致死亡。因此，密切监测血糖值，并将其控制在理想范围内，对于改善重症患者的预后有积极作用。
指尖血糖测定是一种通过指端采血来测定血糖值的方法，具有测量结果准确、等待时间短、操作简便、患者出血量少等特点。因此，指尖血糖监测为及时发现危重患者的高血糖、低血糖和了解血糖波动情况带来极大的方便，临床中已得到广泛的应用。在国内外的临床实践中，使用第一滴和第二滴指尖血进行血糖监测的情况都有存在，既往的研究结果也不尽一致。因此，本研究拟通过分析重症患者血糖监测中使用第一滴和第二滴指尖血是否存在差异，为临床操作提供参考，现报道如下。
1资料与方法
1.1一般资料
采用抽签法选取2016年9～11月在重庆医科大学附属永川医院入住ICU的30例患者作为研究对象，男21例，女9例，年龄25～96岁，平均(60.4±16.8)岁，共收集有效数据52组。指尖皮肤有污染、破损、水肿、长茧及凝血功能障碍、严重脱水、采血局部循环差的患者不列入本研究[5-6]。本研究方案经我院医学伦理学委员会批准，取得患者或家属的同意，并签署知情同意书。, http://www.100md.com(程琳芝 丁丽娜 吴晓英)