使用可穿戴糖尿病设备的患者围手术期护理。

IF 4.6 2区 医学 Q1 ANESTHESIOLOGY
Anesthesia and analgesia Pub Date : 2025-01-01 Epub Date: 2024-01-24 DOI:10.1213/ANE.0000000000007115
Paulina Cruz, Alexis M McKee, Hou-Hsien Chiang, Janet B McGill, Irl B Hirsch, Kyle Ringenberg, Troy S Wildes
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引用次数: 0

摘要

随着糖尿病发病率的不断上升,可穿戴式连续血糖监测(CGM)设备和胰岛素泵也在迅速发展。在 "闭环 "中将这些组件结合在一起的系统越来越常见,在 "闭环 "中,间质葡萄糖测量根据复杂的算法指导胰岛素的自动输送(AID,或闭环)。虽然这些设备在实现接近正常血糖值方面的功效促使糖尿病患者越来越多地使用这些设备,但对这些患者在手术和程序环境中的管理研究仍然不足,出版的指南也很有限,尤其是关于 AID 系统的指南。随着 AID 系统的日益普及,需要提供实用的管理建议,以便在手术护理期间使用这些系统,或合理地临时替代其他糖尿病监测和治疗方法。CGM 设备可实时监测血糖间期,但在围手术期的使用和准确性方面存在潜在的局限性,因此目前不应以其取代常规的护理点血糖监测。尽可能避免在围手术期移除 CGM 非常重要,因为移除这些处方设备会导致在手术期间和手术后长时间中断 CGM 指导的治疗,尤其是 AID 系统的使用。独立的胰岛素泵可持续提供皮下胰岛素,无需根据血糖浓度进行自动调整,在某些手术过程中可以继续使用。术中安全使用 AID 设备的混合闭环模式(AID 模式)需要系统中的 CGM 组件继续传输有效的血糖数据,因此还需要确保系统的这一部分正常运行,以便术中使用。当配对的 CGM 断开连接或闭环模式被故意禁用时,AID 设备会恢复到非 AID 胰岛素治疗模式。对于使用胰岛素泵的患者,我们描述了可能会影响 CGM、胰岛素泵和 AID 使用的程序因素,从而需要主动过渡到其他胰岛素方案。手术持续时间和侵入性是一个重要因素,因为较长的手术会增加应激性高血糖、组织灌注不良和设备故障的风险。是继续使用胰岛素泵,还是用其他胰岛素给药方法替代,这是一个复杂的决定,需要各方了解与患者和手术因素相关的潜在风险和应急计划。本文回顾了目前可用的 CGM 和胰岛素泵,并提供了在围手术期护理阶段进行安全血糖管理的实用建议。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Perioperative Care of Patients Using Wearable Diabetes Devices.

The increasing prevalence of diabetes mellitus has been accompanied by a rapid expansion in wearable continuous glucose monitoring (CGM) devices and insulin pumps. Systems combining these components in a "closed loop," where interstitial glucose measurement guides automated insulin delivery (AID, or closed loop) based on sophisticated algorithms, are increasingly common. While these devices' efficacy in achieving near-normoglycemia is contributing to increasing usage among patients with diabetes, the management of these patients in operative and procedural environments remains understudied with limited published guidance available, particularly regarding AID systems. With their growing prevalence, practical management advice is needed for their utilization, or for the rational temporary substitution of alternative diabetes monitoring and treatments, during surgical care. CGM devices monitor interstitial glucose in real time; however, there are potential limitations to use and accuracy in the perioperative period, and, at the present time, their use should not replace regular point-of-care glucose monitoring. Avoiding perioperative removal of CGMs when possible is important, as removal of these prescribed devices can result in prolonged interruptions in CGM-informed treatments during and after procedures, particularly AID system use. Standalone insulin pumps provide continuous subcutaneous insulin delivery without automated adjustments for glucose concentrations and can be continued during some procedures. The safe intraoperative use of AID devices in their hybrid closed-loop mode (AID mode) requires the CGM component of the system to continue to communicate valid blood glucose data, and thus introduces the additional need to ensure this portion of the system is functioning appropriately to enable intraprocedural use. AID devices revert to non-AID insulin therapy modes when paired CGMs are disconnected or when the closed-loop mode is intentionally disabled. For patients using insulin pumps, we describe procedural factors that may compromise CGM, insulin pump, and AID use, necessitating a proactive transition to an alternative insulin regimen. Procedure duration and invasiveness is an important factor as longer procedures increase the risk of stress hyperglycemia, tissue malperfusion, and device malfunction. Whether insulin pumps should be continued through procedures, or substituted by alternative insulin delivery methods, is a complex decision that requires all parties to understand potential risks and contingency plans relating to patient and procedural factors. Currently available CGMs and insulin pumps are reviewed, and practical recommendations for safe glycemic management during the phases of perioperative care are provided.

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来源期刊
Anesthesia and analgesia
Anesthesia and analgesia 医学-麻醉学
CiteScore
9.90
自引率
7.00%
发文量
817
审稿时长
2 months
期刊介绍: Anesthesia & Analgesia exists for the benefit of patients under the care of health care professionals engaged in the disciplines broadly related to anesthesiology, perioperative medicine, critical care medicine, and pain medicine. The Journal furthers the care of these patients by reporting the fundamental advances in the science of these clinical disciplines and by documenting the clinical, laboratory, and administrative advances that guide therapy. Anesthesia & Analgesia seeks a balance between definitive clinical and management investigations and outstanding basic scientific reports. The Journal welcomes original manuscripts containing rigorous design and analysis, even if unusual in their approach.
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