摘要
目的探讨实时动态血糖监测系统(GRT)在低血糖高危新生儿中应用的可行性。方法选取2015年5月至2016年12月在复旦大学附属儿科医院新生儿重症监护病房(NICU)住院治疗的低血糖高危新生儿72例,其中男43例,女29例;胎龄(35.25±4.45)周;出生体质量(2 385.69±1 062.63) g。应用GRT(美国美敦力公司)连续监测组织间液的葡萄糖浓度,同时应用快速血糖仪(罗氏ACCU-CHEK?)间断监测末梢血糖。结果共收集1 134对GRT监测组织间液葡萄糖数值[(5.19±1.99) mmol/L]与末梢血糖值[(5.23±1.96) mmol/L],配对t检验显示两者呈正相关(r=0.88,P<0.05),且两者一致性好[平均绝对误差(MAD)=11.88%]。以末梢血糖作为参考血糖,Clarke误差表格分析显示:低血糖高危新生儿中GRT监测间质葡萄糖值98.24%的点位于A区和B区,其余20个点(1.76%)位于D区。定义低血糖为血糖浓度<2.6 mmol/L,高血糖为血糖浓度>7.0 mmol/L。末梢血糖监测到一次高/低血糖即为一个高/低血糖事件,GRT监测到一连续时间段内的高/低血糖即为一个高/低血糖事件。快速血糖仪检测低血糖病例12例,低血糖事件26个,高血糖病例29例,高血糖事件151个。GRT监测低血糖病例26例,低血糖事件88个,高血糖病例38例,高血糖事件229个。有62个低血糖事件未被快速血糖仪检测方法检测,持续时间>30 min低血糖事件14个,持续时间>60 min低血糖事件4个,持续时间>90 min低血糖事件5个。有78个高血糖事件未被快速血糖仪检测,持续时间>30 min高血糖事件44个,持续时间>60 min高血糖事件15个,持续时间>90 min高血糖事件70个。2种血糖检测方法在低血糖监测及血糖异常检出率上的差异有统计学意义(χ^2=7.00、18.60,均P<0.05),而在高血糖检出率上差异无统计学意义(χ^2=2.26,P>0.05)。家长、医护人员及患儿接受度可,仅有3个在探针置入过程中轻微出血,但出血量无进行性增加,探针置入部位无血肿、渗出和感染,整个监测过程中患儿无不适。结论GRT应用于低血糖高危新生儿的血糖监测是可行的,较常规间断末梢血糖监测方法可监测到更多血糖异常事件及其持续时间。
Objective To explore the feasibility of Guardian real-time continuous monitoring system(GRT) in high-risk infants with hypoglycemia. Methods The glucose of 72 infants admitted to Neonatal Intensive Care Unit(NICU) of Children′s Hospital of Fudan University between May 2015 and December 2016 were detected by GRT (provided by Medtronic), there were 43 males and 29 females with gestational age [(35.25±4.45) weeks], and birth weight [(2 385.69±1 062.63) g]. At the same time, the capillary glucose was monitored intermittently detected by using ACCU-CHEK?. Results A total of 1 134 paired glucose levels were collected.A good correlation between the paired capillary[(5.23±1.96) mmol/L] and GRT continuous monitor measurements [(5.19±1.99) mmol/L] was found(r=0.88, P<0.05), and the value of mean absolute difference (MAD) was 11.88%.Through the Clarke error grid analysis, there were 98.24 % points located in region A and region B, only 20 paired(1.76%) glucose located in region D. Hypoglycemia was defined as glucose concentration <2.6 mmol/L, while hyperglycemia was defined as glucose concentration >7.0 mmol/L.A high/low blood glucose detected by peripheral blood glucose monitoring is a high/low blood glucose event, and a high/low blood glucose detected by GRT in a continuous period is a high/low blood glucose event.Twelve cases of hypoglycemia, 26 episodes of hypoglycemia, 29 cases of hyperglycemia, and 151 episodes of hyperglycemia were detected by using fast blood glucose meter.Twenty-six cases of hypoglycemia, 88 episodes of hypoglycemia, 38 cases of hyperglycemia, and 229 episodes of hyperglycemia were detected by using GRT.Sixty-two episodes of hypoglycemia were not detected by the fast blood glucose meter, with 14 episodes lasting longer than 30 min, 4 longer than 60 min, and 5 longer than 90 min.There were 78 hyperglycemic episodes that were not detected by the fast blood glucose meter, with 44 episodes lasting longer than 30 min, 15 longer than 60 min, and 70 longer than 90 min.There were significant differences in the testing of hypoglycemia and pathoglycemia(χ^2=7.00, 18.60;all P<0.05), but, there was no significant difference in the testing of hyperglycemia between the 2 kinds of detection(χ^2=2.26, P>0.05). GRT was acceptable to parents, medical staffs and children as only 3 infants bled when the continuous glucose sensor was imbedded, but there was no progressive increase in blood loss.There was no redness, edema, infections, or effusions at the insertion sites. Conclusions The use of GRT continuous monitoring system in high-risk infants of hypoglycemia was feasible.Compared with the conventional intermittent peripheral blood glucose monitoring, more abnormal blood glucose events and their duration could be detected.
作者
刘宁
程国强
张鹏
严恺
周文浩
Liu Ning;Cheng Guoqiang;Zhang Peng;Yah Kai;Zhou Wenhao(Department of Pediatrics,General Hospital of Northern Theater Command,Shenyang 110016,China;Department of Neonatal Pediatrics,the Children's Hospital of Fudan University,Shanghai 201102,China)
出处
《中华实用儿科临床杂志》
CSCD
北大核心
2019年第1期19-23,共5页
Chinese Journal of Applied Clinical Pediatrics
基金
上海市自然科学基金(16411953400).
关键词
低血糖
婴儿
新生
实时动态血糖监测系统
Hypoglycemia
Infants,newborn
Real-time continuous monitoring system
