重庆地区医院信息化血糖管理监测数据分析

AnanalysisofmonitoringdataofinformationizedbloodglucosemanagementinhospitalsinChongqing，China

摘要:

目的：根据区域内的糖尿病流行病学和糖尿病防治管理现状，利用信息化技术手段，通过患者血糖大数据分析，评价住院糖尿病患者血糖变化趋势，了解住院患者血糖监控的薄弱环节，从而指导临床血糖管理。方法：基于多中心的信息化血糖管理平台，于2016年9月至2018年1月收集重庆医科大学附属永川医院、重庆医科大学附属第二医院、重庆三峡中心医院共10608例住院糖尿病患者床旁血糖数据，采用群体模型（populationmodel）、个体模型（patientmodel）、人-时模型（patient-daymodel）分析住院糖尿病患者的血糖构成比：高血糖、低血糖、理想血糖占比等情况。结果：共收集快速床旁监测（point-of-caretesting，POCT）血糖数据253738个，采用群体模型分析，高血糖达38.3%，理想血糖仅占20.5%；采用个体模型分析，住院期间曾发生低血糖的患者占13.2%，其中曾出现严重低血糖的患者占1.2%，发生严重低血糖患者为低血糖患者的9.4%；采用人-时模型分析，理想血糖的患者人时数为49.6%，高血糖发生率为60.2%，严重高血糖发生率为18.8%。结论：住院糖尿病患者的理想血糖占比低，高血糖占比高，经过一段时间住院治疗后高血糖发生率呈下降趋势，但传统内分泌科被动会诊模式导致部分高血糖事件处理不及时。所有时间段均发生了低血糖事件，且部分患者发生了严重低血糖事件，午餐前与空腹为高发时段，晚餐前血糖监测频次低。

Abstract:

Objective：Toevaluatethebloodglucosechangesinhospitalizedpatientswithdiabetesbybigdataanalysisofpatientsus－inginformationtechnologyaccordingtotheepidemiologyofdiabetesandthecurrentstatusofprevention，treatment，andmanagementofdiabetesintheregion，tounderstandtheweaklinksofmonitoringhospitalizedpatients'bloodglucose，andtoguideclinicalbloodglucosemanagement.Methods：Basedonamulticenterinformationizedbloodglucosemanagementplatform，fromSeptember2016toJanuary2018，thebedsidebloodglucosedataof10608hospitalizedpatientswithdiabeteswerecollectedfromtheYongchuanHospi－talofChongqingMedicalUniversity，TheSecondAffiliatedHospitalofChongqingMedicalUniversity，andtheChongqingThreeGorgesCentralHospital.Thepopulationmodel，patientmodel，andpatient-daymodelwereusedtoanalyzethebloodglucoseconstituentratioofinpatientswithdiabetes：proportionsofpatientswithhyperglycemia，hypoglycemia，andidealbloodglucoselevel.Results：Atotalof253738point-of-caretestingbloodglucosemonitoringdatawerecollected.Thepopulationmodelanalysisshowedthattheprevalenceofhyperglycemiareached38.3%，andtheindividualswithanidealbloodglucoselevelonlyaccountedfor20.5%.Thepatientmodelanalysisshowedthat13.2%ofthepatientshadhypoglycemiaduringhospitalization；patientswithseverehypoglycemiaaccountedfor1.2%；patientswithseverehypogl-ycemiaaccountedfor9.4%ofpatientswithhypoglycemia.Thepatient-daymodelanalysisshowedthatthepatientswithanidealbloodglucoselevelaccountedfor49.6%；theincidenceofhyperglycemiawas60.2%；theincidenceofseverehyperglycemiawas18.8%.Conclusion：Theproportionofhospitalizeddiabetespatientswithanidealbloodglucoselevelislow，andthepro－portionofthosewithhyperglycemiaishigh.Afteraperiodofhospitalization，theincidenceofhyperglycemiaisdecreasing，butthetra－ditionalendocrinologypassiveconsultationmodecausesthatsomehyperglycemiaeventsarenotmanagedintime.Hypoglycemiaeventsoccurinalltimeperiods，andsomepatientshaveseverehypoglycemiaevents.Thehigh-riskperiodsofhypoglycemiaarebeforelunchandfasting.Thefrequencyofbloodglucosemonitoringbeforedinnerislow.