Plos Med:葡萄糖凝胶有效降低新生儿低血糖发生率,但无法减少重症监护病房入院率

2021-02-23 MedSci原创 MedSci原创

低血糖症是指由多种原因引起的血糖浓度过低所致的综合征。一般以血浆血糖浓度<2.8mmol/L,或全血葡萄糖<2.5mmol/L为低血糖。儿童低血糖诊断标准比成人值低1.11mmol/L。低

低血糖症是指由多种原因引起的血糖浓度过低所致的综合征。一般以血浆血糖浓度<2.8mmol/L,或全血葡萄糖<2.5mmol/L为低血糖。儿童低血糖诊断标准比成人值低1.11mmol/L。低血糖症在新生儿中很常见,多项研究显示,即使是暂时性的,也可导致脑损伤。

目前,葡萄糖凝胶被广泛用于治疗新生儿低血糖症,便宜且安全。先前的一项研究表明,单剂量200mg/kg预防性葡萄糖凝胶可以降低高危婴儿低血糖的发生。但尚不清楚这是否可以改善临床上重要的结局,例如新生儿重症监护。近日,发表在Plos Med杂志的一项研究显示,200mg/kg预防性葡萄糖凝胶并不能降低新生儿重症监护室(NICU)的入院率,但可以降低低血糖症。

在这项随机对照试验中,研究人员对来自20151月至20195月新西兰和澳大利亚的18家妇产医院2149名婴儿,并将其随机分配至葡萄糖凝胶组和安慰剂组。主要结局为重症监护病房(NICU)入院以及住院时间超过4小时。次要结局包括低血糖,因低血糖而入住NICU,高血糖,出院时母乳喂养,6周时配方奶喂养和产妇满意度。

研究结果显示,98%的新生儿接受了葡萄糖凝胶治疗,并且耐受性良好。新生儿NICU的总体入院率为9.9%,与葡萄糖凝胶组和安慰剂组因低血糖而发生NICU入院相似,分别为10.4%9.4%

然而,在葡萄糖凝胶组,新生儿几乎没有发生低血糖事件。在出院时母乳喂养(aRR 1.0095% CI 0.991.02p = 0.67)、出院前接受配方奶(aRR 0.9995% CI 0.921.08p = 0.90)、6周时配方奶喂养(aRR 1.0195% CI 0.931.10p = 0.81)等方面组间无差异,且无高血糖发生。

总之,预防性葡萄糖凝胶并没有减少NICU入院人数,然而,它确实减少了低血糖的发生率。因此,临床医生和临床指南组应考虑将其预防性葡萄糖凝胶引入临床实践,进而更好的筛查新生儿低血糖发生的发病率,以预防脑损伤。未来,需要对更大规模数据进行随访,进一步评估预防性葡萄糖凝胶在预防新生儿低血糖症中的临床效用。

原始出处

Jane E. Harding et al.Evaluation of oral dextrose gel for prevention of neonatal hypoglycemia (hPOD): A multicenter, double-blind randomized controlled trial.Plos Med.2021.https://doi.org/10.1371/journal.pmed.1003411

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    2021-03-17 托樂山

    有没有具体的使用标准啊?

    0

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  5. [GetPortalCommentsPageByObjectIdResponse(id=1826671, encodeId=8e7318266e12f, content=<a href='/topic/show?id=e5283e89970' target=_blank style='color:#2F92EE;'>#发生率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37899, encryptionId=e5283e89970, topicName=发生率)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30bd35, createdName=一叶知秋, createdTime=Mon Apr 12 04:57:35 CST 2021, time=2021-04-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1748116, encodeId=14241e4811692, content=<a href='/topic/show?id=9f672636086' target=_blank style='color:#2F92EE;'>#低血糖发生率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26360, encryptionId=9f672636086, topicName=低血糖发生率)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=aea936056349, createdName=DEXTER3151, createdTime=Thu Feb 03 17:57:35 CST 2022, time=2022-02-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=949036, encodeId=23bb94903668, content=有没有具体的使用标准啊?, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210202/2681af985ccd40b39ded51cfc32bd904/6cc1c39e053b404eaf7399f7fc051ccb.jpg, createdBy=5d105458123, createdName=托樂山, createdTime=Wed Mar 17 17:54:11 CST 2021, time=2021-03-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1361020, encodeId=0edf13610205b, content=<a href='/topic/show?id=422158460f9' target=_blank style='color:#2F92EE;'>#新生儿低血糖#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=58460, encryptionId=422158460f9, topicName=新生儿低血糖)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=04ce158, createdName=lxg951, createdTime=Thu Feb 25 07:57:35 CST 2021, time=2021-02-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1368855, encodeId=aa72136885523, content=<a href='/topic/show?id=3d849596588' target=_blank style='color:#2F92EE;'>#重症监护病房#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95965, encryptionId=3d849596588, topicName=重症监护病房)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4a4d285, createdName=日月, createdTime=Thu Feb 25 07:57:35 CST 2021, time=2021-02-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1461072, encodeId=dc9014610e253, content=<a href='/topic/show?id=de4331310a4' target=_blank style='color:#2F92EE;'>#凝胶#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=31310, encryptionId=de4331310a4, topicName=凝胶)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e09e6383467, createdName=lishizhe, createdTime=Thu Feb 25 07:57:35 CST 2021, time=2021-02-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1551195, encodeId=2d951551195b0, content=<a href='/topic/show?id=e2c1e230796' target=_blank style='color:#2F92EE;'>#监护#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=72307, encryptionId=e2c1e230796, topicName=监护)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=477814173963, createdName=bioon6, createdTime=Thu Feb 25 07:57:35 CST 2021, time=2021-02-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1610917, encodeId=2b6a161091e31, content=<a href='/topic/show?id=eb6b1145939' target=_blank style='color:#2F92EE;'>#Med#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11459, encryptionId=eb6b1145939, topicName=Med)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=552a19396740, createdName=ms3994565386320060, createdTime=Thu Feb 25 07:57:35 CST 2021, time=2021-02-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=926648, encodeId=8c2792664845, content=共同进步, beContent=null, objectType=article, channel=null, level=null, likeNumber=100, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cc315416492, createdName=ms9000000058794467, createdTime=Tue Feb 23 17:08:09 CST 2021, time=2021-02-23, status=1, ipAttribution=)]
  6. [GetPortalCommentsPageByObjectIdResponse(id=1826671, encodeId=8e7318266e12f, content=<a href='/topic/show?id=e5283e89970' target=_blank style='color:#2F92EE;'>#发生率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=53, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37899, encryptionId=e5283e89970, topicName=发生率)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30bd35, createdName=一叶知秋, createdTime=Mon Apr 12 04:57:35 CST 2021, time=2021-04-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1748116, encodeId=14241e4811692, content=<a href='/topic/show?id=9f672636086' target=_blank style='color:#2F92EE;'>#低血糖发生率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=66, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=26360, encryptionId=9f672636086, topicName=低血糖发生率)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=aea936056349, createdName=DEXTER3151, createdTime=Thu Feb 03 17:57:35 CST 2022, time=2022-02-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=949036, encodeId=23bb94903668, content=有没有具体的使用标准啊?, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210202/2681af985ccd40b39ded51cfc32bd904/6cc1c39e053b404eaf7399f7fc051ccb.jpg, createdBy=5d105458123, createdName=托樂山, createdTime=Wed Mar 17 17:54:11 CST 2021, time=2021-03-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1361020, encodeId=0edf13610205b, content=<a href='/topic/show?id=422158460f9' target=_blank style='color:#2F92EE;'>#新生儿低血糖#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=58460, encryptionId=422158460f9, topicName=新生儿低血糖)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=04ce158, createdName=lxg951, createdTime=Thu Feb 25 07:57:35 CST 2021, time=2021-02-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1368855, encodeId=aa72136885523, content=<a href='/topic/show?id=3d849596588' target=_blank style='color:#2F92EE;'>#重症监护病房#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=95965, encryptionId=3d849596588, topicName=重症监护病房)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4a4d285, createdName=日月, createdTime=Thu Feb 25 07:57:35 CST 2021, time=2021-02-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1461072, encodeId=dc9014610e253, content=<a href='/topic/show?id=de4331310a4' target=_blank style='color:#2F92EE;'>#凝胶#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=43, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=31310, encryptionId=de4331310a4, topicName=凝胶)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e09e6383467, createdName=lishizhe, createdTime=Thu Feb 25 07:57:35 CST 2021, time=2021-02-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1551195, encodeId=2d951551195b0, content=<a href='/topic/show?id=e2c1e230796' target=_blank style='color:#2F92EE;'>#监护#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=72307, encryptionId=e2c1e230796, topicName=监护)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=477814173963, createdName=bioon6, createdTime=Thu Feb 25 07:57:35 CST 2021, time=2021-02-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1610917, encodeId=2b6a161091e31, content=<a href='/topic/show?id=eb6b1145939' target=_blank style='color:#2F92EE;'>#Med#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11459, encryptionId=eb6b1145939, topicName=Med)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=552a19396740, createdName=ms3994565386320060, createdTime=Thu Feb 25 07:57:35 CST 2021, time=2021-02-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=926648, encodeId=8c2792664845, content=共同进步, beContent=null, objectType=article, channel=null, level=null, likeNumber=100, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cc315416492, createdName=ms9000000058794467, createdTime=Tue Feb 23 17:08:09 CST 2021, time=2021-02-23, status=1, ipAttribution=)]
    2021-02-25 lishizhe
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    2021-02-25 bioon6
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    2021-02-23 ms9000000058794467

    共同进步

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