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护理学报 ›› 2021, Vol. 28 ›› Issue (15): 42-47.doi: 10.16460/j.issn1008-9969.2021.15.042

• 循证护理 • 上一篇    下一篇

糖尿病患者急性卒中后血糖监测及管理的最佳证据总结

卢舒颖1, 刘宁1, 廉民学2   

  1. 1.遵义医科大学珠海校区 护理学系,广东 珠海 519041;
    2.西安交通大学第一附属医院 神经外科,陕西 西安 710000
  • 收稿日期:2021-03-07 出版日期:2021-08-10 发布日期:2021-09-10
  • 通讯作者: 刘宁（1981-）,女,陕西西安人,博士,副教授,南方医院JBI循证护理合作中心导师库成员。E-mail：761066906@qq.com
  • 作者简介:卢舒颖（1998-）,女,福建龙岩人,本科在读,护士。
  • 基金资助:
    贵州省大学生创新训练项目（2020,S202010661013）; 遵义市科技局遵义医科大学科学技术联合资金项目[遵市科合HZ字（2020）38号]; 遵义医科大学珠海校区2018年度校区级教学教育改革计划项目（XQJG2018-03-01,XQJG2018-03-02）; 珠海市哲学社会科学规划2019-2020年度课题（2019ZC166）

Best Evidence Summary of Blood Glucose Monitoring and Management in Diabetes Patients with Acute Stroke

LU shu-ying1, LIU ning1, LIAN Min-xue2   

  1. 1. Dept. of Nursing, Zunyi Medical University, Zhuhai Campus, Zhuhai 519041, China;
    2. Dept. of Neurosurgery,the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710000, China
  • Received:2021-03-07 Online:2021-08-10 Published:2021-09-10

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摘要： 目的 检索有关糖尿病患者急性卒中后血糖监测及管理的相关证据,并汇总最佳证据供临床参考。方法 根据循证护理的方法,按照“6S”证据模型,利用计算机检索国内外有关糖尿病患者急性卒中后血糖监测及管理的临床决策、指南、系统评价、随机对照试验、证据总结和专家共识,由2名经过循证护理系统化培训的研究员对纳入的文献进行独立评价,并对通过质量评价的文献进行证据提取。结果 共纳入13篇文献,其中临床决策1篇、指南6篇、系统评价1篇、随机对照试验2篇、证据总结1篇和专家共识2篇,并从中汇总23条证据,最后从6个维度总结了14条最佳证据。结论 对于糖尿病患者急性卒中后的血糖管理要遵循个性化和多样化原则,在降糖治疗的同时要充分考虑患者的实际情况,为其制定个性化的降糖方案;同时也要注意低血糖带来的危害,加强血糖监测,避免低血糖的发生。

关键词: 糖尿病, 急性卒中, 血糖管理, 循证护理学, 最佳证据

Abstract: Objective To retrieve the relevant evidence of monitoring and management of blood glucose after acute stroke in diabetic patients and summarize the best evidence for clinical reference. Methods With the method of evidence-based nursing, in accordance with the "6s" evidence model, we collected clinical decision , guideline, systematic review, randomized controlled trial, evidence summaries and expert consensus about blood sugar monitoring and management in diabetes patients with acute stroke at home and abroad. Two researchers after systematic training of evidence-based nursing evaluated the quality of the literature and extracted the evidence. Results Thirteen articles were included: 1 clinical decision, 6 guidelines, 1 systematic evaluation, 2 randomized controlled trials, 1 evidence summary and 2 expert consensus. Totally 23 pieces of evidence were summarized, and 14 pieces of best evidence were finally summarized from 6 dimensions. Conclusion Blood glucose management after acute stroke in diabetic patients should be individualized and diversified. In addition to hypoglycemic treatment, the actual situation of the patients should be fully considered and personalized hypoglycemic plan should be formulated. At the same time, we should also pay attention to the harm caused by hypoglycemia, strengthen blood glucose monitoring, and avoid the occurrence of hypoglycemia.

Key words: diabetes, acute stroke, management of blood glucose, evidence-based nursing, best evidence

中图分类号: 

  • R473.58
[1] Roretta TL.Glycemic Control in the Diabetic Patient after Stroke[J]. Crit Care Nurs Clin North Am, 2009, 21(4):507-515. DOI:10.1016/j.ccell.2009.08.002.
[2] Piironen K, Putaala J, Rosso C, et al.Glucose and Acute Stroke: Evidence for an Interlude[J]. Stroke, 2012, 43(3): 898-902. DOI:10.1161/STROKEAHA.111.631218.
[3] 陈厚斌,韩肇木,喻佛定,等.糖尿病病程与脑卒中发病风险的关系[J].中国现代医学杂志,2015,25(2):68-72.
[4] 中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国缺血性脑卒中和短暂性脑缺血发作二级预防指南2014[J].中华神经科杂志,2015,48(4):68-74.DOI:10.3760/cma.j.issn.1006-7876.2015.04.003.
[5] 段璐,董其娟. 糖尿病合并急性期脑卒中患者血糖变异性与短期不良预后的相关性[J].中国糖尿病杂志,2017,25(1):53-57.DOI:10.3969/j.issn.1006-6187.2017.01.012.
[6] Johnston KG, Bruno A, Pauls Q, et al.Intensive vs Standard Treatment of Hyperglycemia and Functional Outcome in Patients with Acute Ischemic Stroke:The SHINE Randomized Clinical Trial[J]. JAMA,2019,322(4):326-335.DOI:10.1001 / jama.2019.9346.
[7] 张晟奕,郭怡菁.卒中后高血糖机制及其管理策略[J].中国脑血管病杂志,2013,7(3):15-18.DOI:10.3877/cma.j.issn.1673-9248.2013.03.004.
[8] 杨琳,崔敬艳,王莉,等. 非内分泌科护士对糖尿病患者血糖管理的规范化培训与实践[J]. 中国护理管理,2017,17(8):1149-1151.DOI: 10.3969/j.issn.1672-1756.2017.08.033.
[9] Dicenso A, Bayley L, Haynes RB, et al.Accessing Pre-appraised Evidence:Fine-tuning the 5S Model into a 6S Model[J]. Evid Based Nurs,2009,12(4):99.DOI:10.1136/ebn.12.4.99-b.
[10] Brouwers MC, Kho ME, Browman GP, et al.AGREE II: Advancing Guideline Development,Reporting,and Evaluation in Health Care[J]. Prev Med, 2010,51(5):421-424.DOI:10.1016/j.jclinepi.2010.07.001.
[11] Shea BJ, Reeves BC, Wells G, et al.AMSTAR 2: Acritical Appraisal Tool for Systematic Review that Include Randomised or Non-randomised Studies of Healthcare Intervention, or Both[J]. BMJ,2017,358:j4008.DOI:10.1136/bmj.j4008.
[12] The Joanna Briggs Institute(JBI). Critical Appraisal Tools [EB/OL].[2019-09-18].http://joannabriggs.org/research/critical-appraisal-tools.html.
[13] 米元元,沈月,郝彬. ICU患者从肠内营养支持并发腹泻的循证护理实践[J]. 中华护理杂志,2017,53(11):1291-1298.DOI:10.3761./j.issn.0254-1769.2017.11.002.
[14] 王春青,胡雁. JBI证据预分级及证据推荐级别系统(2014版)[J]. 护士进修杂志, 2015,30(11):964-967.
[15] Jamary OF, Michael TM. Initial Assessment and Management of Acute Management of Acute Stroke[EB/OL].(2019-08-02)[2020-03-10].http://www.uptodate.com.consultarenmota.upb.edu.co/.
[16] Polskie Towarzystwo Diabetologicz.2019 Guidelines on the Management of Diabetic Patients—A Position of Diabetes Poland[J]. Clinical Diabetology, 2019, 8(1):1-97.DOI:10.5603/DK.2019.0001.
[17] Joint British Diabetes Societies. Glycaemic Management During the Inpatient Enteral Feeding of People with Stroke and Diabetes[J]. Diabet Med,2018,35(8):1027-1036.DOI: 10.1111/dme.13678.
[18] Powers WJ, Rabinstein AA, Ackerson T, et al.Guidelines for the Early Management of Patients with Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke:A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association[J]. Stroke, 2019,50(12):e344-e418.DOI:10.1161/STR.0000000000000215.
[19] Billod F, George N, Jukka P, et al.European Stroke Organisation (ESO) Guidelines on Glycaemia Management in Acute Stroke[J]. Eur Stroke J,2018,3(1):5-21.DOI:10.1177/2396987317742065.
[20] 中华医学会神经病学分会.中国急性缺血性脑卒中诊治指南2018[J]. 中国神经科杂志,2018,51(9):666-682.DOI:10.3760/cma.j.issn.1006-7876.2018.09.004.
[21] 国家卫生计生委脑卒中防治工程委员会.中国脑卒中血糖管理指导规范[J].全科医学临床与教育,2016(1):3-5.
[22] Bellolio M, Gilmore RM, Ganti L. Insulin for Glycaemic Control in Acute Ischaemic Stroke[J]. Cochrane Database Syst Rev, 2014,23(1):CD005346.DOI:10.1002/14651858.CD005346.pub3.
[23] Johnston KG, Bruno A, Pauls Q, et al.Intensive vs Standard Treatment of Hyperglycemia and Functional Outcome in Patients with Acute Ischemic Stroke: The SHINE Randomized Clinical Trial[J]. JAMA, 2019,322(4):326-335.DOI:10.1001/jama.2019.9346.
[24] 朱菊训,刘玲,闫金玲,等.胰岛素泵治疗在脑卒中合糖尿病病人肠内营养实施中的应用评价[J].肠外与肠内营养,2019, 26(4):223-227.DO:10.16151/J.1007-810x.2019.04.007.
[25] Lauren D. Blood Glucose (Cerebrovascular Accident) [EB/OL].(2019-05-28)[2020-03-10].https://ovidsp.dc1.ovid.com/ovid-a/ovidweb.cgi/ blood glucose/cerebrovascular accident.
[26] 中华护理学会糖尿病护理专业委员会.住院成人高血糖患者血糖监测医护协议处方共识[J].中华护理杂志,2019,54(8):1142-1147. DOI:10.3761/j.issn.0254-1769.2019.08.004.
[27] Davies MJ, D’Alessio DA, Fradkin J, et al. Management of Hyperglycemia in Type 2 Diabetes,2018. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)[J]. Diabetes Care, 2018,41(2):2669-2701.DOI:10.2337/dci18-0033.
[28] Lik HL, Jeremy L, Karen B, et al.Prevalence of Diabetes and Its Effects on Stroke Outcomes:A Meta-anylsis and Literature Review[J]. J Diabetes Investig,2019, 10(3):780-792.DOI:10.1111/jdi.12932.
[29] 余珂,何凌霄,杨蓉. 老年2 型糖尿病合并脑卒中血糖控制及综合性护理的效果[J].中国实用神经疾病杂志, 2016,19(5):128-129. DOI:1675-5110(2016)05-0128-02.
[30] Nagahisa T, Saisho Y.Cardiorenal Protection: Potential of SGLT2 Inhibitors and GLP-1 Receptor Agonists in the Treatment of Type 2 Diabetes[J].Diabetes Ther,2019,10(5):1733-1752. DOI:10.1007/s13300-019-00680-5.
[31] Evert AB, Boucher JL, Cypress M, et al.Nutrition Therapy Recommendations for the Management of Adults with Diabetes[J].Diabetes Care, 2014,37(1):120-143. DOI:10.2337/dc14-S120.
[32] 丁小敏,张小丽,邢凤梅,等.脑卒中合并糖尿病患者营养支持研究进展[J].中国老年学杂志,2015,35(23):6933-6935.
[33] 徐晶晶,谢晓峰,黄晓萍,等.非内分泌科胰岛素泵治疗患者的多学科协作优化管理[J].护理学杂志,2015,13(30):22-25. DOI:10.3870/hlxzz.2015.13.022.
[34] 耿永梅,曹闻亚,赵洁,等.手机APP 对出院后首发缺血性脑卒中合并糖尿病患者血糖及自我管理的影响[J].现代临床护理,2018, 17(7):62-67.DOI:10.3969/j.issn.1671-8283.2018.07.013.
[35] 李佳梅,陈鸿芳,刘宁,等.脑梗死偏瘫患者良肢位管理的最佳证据总结[J]. 护理学报,2019,26(24):22-27. DOI:10. 16460/j.issn1008-9969.2019.24.022.
[36] 卢舒颖,刘宁,魏璐华,等.产后出血预防及管理的最佳证据总结[J],2020,27(12):18-22.DOI:10.16460/j.issn1008-9969.2020.12.018.
[37] 周英凤,胡雁,朱政,等.基于证据的持续质量改进模式图的构建[J].中国循证医学杂志, 2017, 17(5):603-606.DOI:10.7507/1672-2531.201611090.
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