以质量求发展，以服务铸品牌

护理学报 ›› 2022, Vol. 29 ›› Issue (7): 50-56.doi: 10.16460/j.issn1008-9969.2022.07.050

• 循证护理 • 上一篇    下一篇

1型糖尿病患儿居家低血糖识别及处理最佳证据总结

王锐a, 李智b, 杨芹c, 王春立c, 李凤婷d, 王旭梅a   

  1. 国家儿童医学中心 首都医科大学附属北京儿童医院 a.内分泌遗传代谢病房; b.呼吸科; c.护理部; d.风湿免疫科,北京 100045
  • 收稿日期:2021-12-21 出版日期:2022-04-10 发布日期:2022-05-10
  • 通讯作者: 王旭梅（1982-）,女,山西晋中人,硕士,副主任护师。E-mail：wangxumei2005@163.com
  • 作者简介:王锐（1970-）,女,北京人,本科学历,副主任护师,护士长。
  • 基金资助:
    河北大学高层次人才科研启动项目（521100221002）

Best Evidence Summary of Hypoglycemia Identification and Management in Homebound Children with Type 1 Diabetes Mellitus

WANG Ruia, LI Zhib, YANG Qinc, WANG Chun-lic, LI Feng-tingd, WANG Xu-meia   

  1. a. Dept. of Endocrinology, Genetics and Metabolism; b. Dept. of Respiration; c. Dept. of Nursing Administration; d. Dept. of Rheumatology and Immunology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
  • Received:2021-12-21 Online:2022-04-10 Published:2022-05-10

赞

摘要： 目的 检索和分析1型糖尿病患儿居家低血糖识别及处理的相关证据,并对最佳证据进行总结。方法 计算机检索BMJ Best Practice、UpToDate、Cochrane Library、JBI、NICE、SIGN、RNAO、IDF,ADA、Web of Science、PubMed、EmBase、中国医脉通临床指南网、中国知网(CNKI)、万方知识数据服务平台和中国生物医学数据库中关于1型糖尿病患儿居家低血糖识别及处理的近5年的指南、证据总结、推荐实践、系统评价、临床决策、专家共识。结果 共纳入10篇文献,其中指南3篇、专家共识3篇、临床决策3篇和系统评价1篇,最终形成最佳证据38条,包括低血糖分级、危险因素识别、低血糖症状识别、低血糖处理、低血糖纠正后处理和居家指导6个方面。结论 本研究所遴选的1型糖尿病患儿居家低血糖识别及处理的证据总结内容较为全面具体,护理人员可基于此对居家1型糖尿病患儿和家长进行低血糖识别和处理方面的健康教育,以及时发现和处理低血糖,确保患儿安全。

关键词: 儿童, 1型糖尿病, 低血糖, 居家护理, 证据总结

Abstract: Objective To search and analyze the evidence related to the identification and treatment of hypoglycemia in children with type 1 diabetes mellitus (T1DM) at home, and summarize the best evidence. Methods The guidelines (BPG), evidence summary (ES), recommended practice (RP), systematic review (SR), clinical decision-making and expert consensus on the identification and management of hypoglycemia in children with T1DM in recent 5 years were searched through BMJ Best Practice,UpToDate,Cochrane Library,JBI,NICE,SIGN,RNAO,IDF,ADA,Web of Science,PubMed,EmBase,Medline,CNKI,Wanfang Database and CBM Database. Results Ten articles were selected, including 3 guidelines, 3 expert consensuses, 3 clinical decision-making and 1 systematic review. Finally, 38 pieces of best evidence were obtained in six aspects of hypoglycemia classification, risk factor identification, hypoglycemia identification, hypoglycemia treatment, measures after recovery from hypoglycemia and family guidance. Conclusion The best evidence summary of hypoglycemia identification and treatment for children with T1DM in this study is comprehensive and specific. Health education on hypoglycemia identification and treatment for children with T1DM and their parents based on the summary will benefit the timely identification of hypoglycemia so as to ensure the safety of children.

Key words: children, type 1 diabetes mellitus, hypoglycemia, home-based care, best evidence summary

中图分类号: 

  • R473.58
[1] Abraham MB, Jones TW, Naranjo D, et al.ISPAD Clinical Practice Consensus Guidelines 2018:Assessment and Management of Hypoglycemia in Children and Adolescents with Diabetes[J]. Pediatr Diabetes, 2018,19(Suppl 27):178-192. DOI:10.1111/pedi.12698.
[2] Cherubini V, Rabbone I, Lombardo F, et al.Incidence of Severe Hypoglycemia and Possible Associated Factors in Pediatric Patients with Type 1 Diabetes in the Real-life, Post-diabetes Control and Complications Trial Setting: A Systematic Review[J]. Pediatr Diabetes,2019,20(6):678-692. DOI:10.1111/pedi.12876.
[3] 栗娟,陈秀荣. 1型糖尿病儿童/青少年父母低血糖恐惧感影响因素研究进展[J]. 护理学报,2019,26(21):31-35. DOI:10.16460/j.issn1008-9969.2019.21.031.
[4] McGill DE, Levitsky LL. Management of Hypoglycemia in Children and Adolescents with Type 1 Diabetes Mellitus[J].Curr Diab Rep, 2016, 16(9):88. DOI:10.1007/s11892-016-0771-1.
[5] 刘建丽,厉红,王兰英.儿童1型糖尿病发生低血糖情况的分析[J].中国生育健康杂志,2016,27(5):457-459;462.DOI:10.3969/j.issn.1671-878X.2016.05.019.
[6] Alkhatatbeh MJ, Abdalqader NA, Alqudah MAY.Impaired Awareness of Hypoglycemia in Children and Adolescents with Type 1 Diabetes Mellitus in North of Jordan[J]. BMC Endocr Disord, 2019, 19(1):107.DOI:10.1186/s12902-019-0441-9.
[7] Jensen MH, Vestergaard P.Hypoglycaemia and Type 1 Diabetes are Associated with an Increased Risk of Fractures[J].Osteoporos Int,2019,30(8):1663-1670.DOI:10.1007/s00198-019-05014-6.
[8] Rama Chandran S, Jacob P, Choudhary P.A Systematic Review of the Effect of Prior Hypoglycaemia on Cognitive Function in Type 1 Diabetes[J].Ther Adv Endocrinol Metab,2020,11:2042018820906017. DOI:10.1177/2042018820906017.
[9] 林露,刘礼斌. 低血糖对糖尿病患者认知功能障碍影响的研究新进展[J].中华内分泌代谢杂志,2021,37(5):485-488. DOI:10.3760/cma.j.cn311282-20201117-00764.
[10] Kacheva S, Karges B, Göller K, et al.QT Prolongation Caused by Insulin-induced Hypoglycaemia-An Interventional Study in 119 Individuals[J]. Diabetes Res Clin Pract, 2017,123:165-172. DOI:10.1016/j.diabres.2016.11.021.
[11] Urakami T.Severe Hypoglycemia: Is It Still a Threat for Children and Adolescents with Type 1 Diabetes?[J].Front Endocrinol(Lausanne),2020,11:609.DOI:10.3389/fendo.2020.00609.
[12] AbitbolL, Palmert MR. When Low Blood Sugars Cause High Anxiety: Fear of Hypoglycemia among Parents of Youth with Type1 Diabetes Mellitus[J]. Can J Diabetes, 2021, 45(5):403-410.DOI:10.1016/j.jcjd.2020.08.098.
[13] Miller D, Mamilly L, Fourtner S,et al.ABM Clinical Protocol #27: Breastfeeding an Infant or Young Child with Insulin-dependent Diabetes[J].Breastfeed Med,2017,12:72-76. DOI:10.1089/bfm.2017.29035.djm.
[14] American Diabetes Association.13. Children and Adolescents:Standards of Medical Care in Diabetes-2020[J].Diabetes Care,2020,43(Suppl 1):S163-S182.DOI:10.2337/dc20-S013.
[15] Tully C, Aronow L, Mackey E, et al.Physical Activity in Youth with Type 1 Diabetes: A Review[J].Curr Diab Rep,2016,16(9):85. DOI:10.1007/s11892-016-0779-6.
[16] Levitsky LL,Misra M.Overview of the Management of Type1 Diabetes Mellitus in Children and Adolescents[EB/OL].(2020-09-03)[2020-11-12].https://www.uptodate.cn/contents/zh-Hans/overview-of-the-management-of-type-1-diabetes-mellitus-in-children-and-adolescents.
[17] 胡雁,郝玉芳.循证护理学[M].2版.北京:人民卫生出版社,2018.
[18] 谢利民,王文岳.《临床指南研究与评价系统Ⅱ》简介[J].中西医结合学报,2012,10(2):160-165.DOI:10.3736/jcim20120206.
[19] 韩柳,杨宏艳,刘飞,等.无针输液接头临床应用的最佳证据总结[J].中华护理杂志,2020, 55(8):1239-1246.DOI:10.3761/j.issn.0254-1769.2020.08.024.
[20] 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.
[21] National Institute for Health and Care Excellence. Type 1 Diabetes in Children and Young People[EB/OL].(2015-08-26)[2021-11-12].https://www.nice.org.uk/guidance/ng18/informationforpublic/type-1-diabetes-in-children-and-young-people/chapter/Low-blood-glucose-hypoglycaemia.
[22] National Institution for Healthy and Care Excellence.Diabetes (Type 1 and Type 2) in Children and Young People: Diagnosis and Management[EB/OL].(2015-08-01)[2020-11-12].https://www.nice.org.uk/guidance/ng18#.
[23] Sundberg F, Barnard K, Cato A, et al.ISPAD Guidelines. Managing Diabetes in Preschool Children[J]. Pediatr Diabetes,2017,18(7):499-517. DOI:10.1111/pedi.12554.
[24] 中华医学会儿科学分会内分泌遗传代谢学组,中华儿科杂志编辑委员会.中国儿童1型糖尿病标准化诊断与治疗专家共识(2020版)[J].中华儿科杂志,2020,58(6):447-454.DOI:10.3760/cma.j.cn112140-20200221-00124.
[25] Levitsky LL, Misra M.Hypoglycemia in Children and Adolescents with Type 1 Diabetes Mellitus[EB/OL].(2020-03-27)[2021-11-12].https://www.uptodate.cn/contents/zh-Hans/hypoglycemia-in-children-and-adolescents-with-type-1-diabetes-mellitus.
[26] Riddell MC.Management of Exercise for Children and Adolescents with Type 1 Diabetes Mellitus[EB/OL].(2020-04-22)[2021-11-12].https://www.uptodate.cn/contents/zh-Hans/management-of-exercise-for-children-and-adolescents-with-type-1-diabetes-mellitus.
[27] Pontiroli AE, Tagliabue E.Intranasal Versus Injectable Glucagon for Hypoglycemia in Type 1 Diabetes:Systematic Review and Meta-analysis[J]. Acta Diabetol, 2020,57(6):743-749. DOI:10.1007/s00592-020-01483-y.
[28] 郝书婕,Anne Folta Fish,楼青青. 1型糖尿病患儿低血糖时升糖激素反应的特异性研究进展[J]. 中华现代护理杂志,2017,23(21):2813-2816. DOI:10.3760/cma.j.issn.1674-2907.2017.21.029.
[29] DiMeglio LA, Acerini CL, Codner E, et al. ISPAD Clinical Practice Consensus Guidelines 2018: Glycemic Control Targets and Glucose Monitoring for Children, Adolescents, and Young Adults with Diabetes[J]. Pediatr Diabetes, 2018,27:105-114. DOI:10.1111/pedi.12737.
[30] 黄洁微,郑妙娜,陈庆玲,等. 1例反复发生低血糖2型糖尿病患者的健康管理[J]. 护理学报,2016,23(21):46-47. DOI:10.16460/j.issn1008-9969.2016.21.046.
[31] 曹冰燕,巩纯秀.儿童糖尿病的葡萄糖监测[J]. 中华实用儿科临床杂志,2019,34(20):1534-1536. DOI:10.3760/cma.j.issn.2095-428X.2019.20.004.
[32] 汤一帆,朱敏,言丹,等. 儿童青少年1型糖尿病患者应用扫描式血糖监测系统的初步观察[J]. 中国糖尿病杂志,2019,27(11):829-833. DOI:10.3969/j.issn.1006-6187.2019.11.007.
[33] Cao B, Wang R, Gong C, et al.An Evaluation of the Accuracy of a Flash Glucose Monitoring System in Children with Diabetes in Comparison with Venous Blood Glucose[J]. J Diabetes Res, 2019,2019:4845729.DOI:10.1155/2019/4845
[34] 陈瑜,林艳,由天辉. 1型糖尿病儿童低血糖事件的影响因素分析[J]. 实用医学杂志,2021,37(2):264-267. DOI:10.3969/j.issn.1006-5725.2021.02.026.
[35] Hershey T, Perantie DC, Warren SL,et al.Frequency and Timing of Severe Hypoglycemia Affects Spatial Memory in Children with Type 1 Diabetes[J]. Diabetes Care, 2005,28(10):2372-2377. DOI:10.2337/diacare.28.10.2372.
[36] 贾竹敏,王曼丽,杜红娜,等. 儿童青少年和成人1型糖尿病低血糖分析[J]. 国际护理学杂志,2018,37(19):2637-2640. DOI:10.3760/cma.j.issn.1673-4351.2018.19.014.
[37] Jackson CC, Albanese-O'Neill A, Butler KL, et al. Diabetes Care in the School Setting: A Position Statement of the American Diabetes Association[J]. Diabetes Care,2015,38(10):1958-1963. DOI:10.2337/dc15-1418.
[38] 王焕焕,程湘玮,王培红,等.妊娠期糖尿病产妇分娩新生儿低血糖管理的最佳证据总结[J]. 护理学报, 2020,27(3):31-36. DOI:10.16460/j.issn1008-9969.2020.03.031.
[39] 中华医学会糖尿病学分会.中国1型糖尿病胰岛素治疗指南[J].中华糖尿病杂志,2016, 8(10):591-597.DOI:10.3760/cma.j.issn.1674-5809.2016.10.005.
[40] Adolfsson P, Riddell MC, Taplin CE, et al.ISPAD Clinical Practice Consensus Guidelines 2018: Exercise in Children and Adolescents with Diabetes[J]. Pediatr Diabetes,2018,27:205-226. DOI:10.1111/pedi.12755.
[1] 李翔, 冯英璞, 孟晓静, 周立民, 霍晓冉, 许梦敏, 王昊. 脑卒中患者口腔健康管理的最佳证据总结[J]. 护理学报, 2022, 29(9): 36-41.
[2] 王琪, 刘腊梅, 陈莉娜, 阙晓玲, 苏绍玉. 基于结构-过程-结果模型儿童支气管镜围术期专科护理质量敏感指标的构建[J]. 护理学报, 2022, 29(8): 69-74.
[3] 曹咪, 张军, 岳少婷. 早产儿出院后神经发育支持性照护的最佳证据总结[J]. 护理学报, 2022, 29(6): 44-49.
[4] 杨阳, 刘宁. 支气管哮喘患者冬病夏治穴位敷贴护理评估及管理的最佳证据总结[J]. 护理学报, 2022, 29(5): 15-21.
[5] 吴玉洁, 吴利平, 冷虹瑶, 王燕, 林光燕. 狗咬伤患者伤口感染预防及管理的最佳证据总结[J]. 护理学报, 2022, 29(5): 52-56.
[6] 晏蓉, 王慧文, 李雪丹, 曾露, 刘欢, 谭海艳, 李瑞, 罗婕. 颈椎前路术后患者吞咽困难管理的证据总结[J]. 护理学报, 2022, 29(4): 40-45.
[7] 张娜, 朱丽辉, 罗听薇, 向玉琼, 熊月娥, 陈牡花, 唐倩. 儿童安宁疗护应用研究进展[J]. 护理学报, 2022, 29(4): 12-16.
[8] 陈鑫, 傅双, 庄珊珊, 芮琳. 手术患者术中测温方式的最佳证据总结[J]. 护理学报, 2022, 29(2): 40-44.
[9] 张榆, 李菀丹, 罗迎霞, 谢杨微. 放化疗鼻咽癌患者消化道症状管理的最佳证据总结[J]. 护理学报, 2022, 29(2): 35-39.
[10] 谢利红, 廖志兰, 石琳, 刘桂英, 孙骊. 肩胛枕的设计及其在儿童锁骨骨折保守治疗中的应用[J]. 护理学报, 2022, 29(10): 76-78.
[11] 殷青霞, 王莉慧, 区洁霞, 文红, 罗笑婷, 刘赛君, 黄心梅, 刘灿灿. 克罗恩病患者饮食管理的证据总结[J]. 护理学报, 2022, 29(1): 47-52.
[12] 王柯, 吴瑾, 黄红玉, 李心仪, 周明明, 吴晓娜. 糖尿病住院患儿规范化医学营养管理的品管圈实践[J]. 护理学报, 2022, 29(1): 13-16.
[13] 陈晶晶, 蔡丹, 韩晨雯, 徐甜. 儿童便秘专科护理门诊的建立与实践[J]. 护理学报, 2022, 29(1): 17-19.
[14] 王琦, 李领侠, 和巾杰, 郑华东, 米晓芬, 胡艳粉. 医护人员低血糖症知信行问卷的编制及信效度检验[J]. 护理学报, 2021, 28(9): 9-13.
[15] 崔朝妹, 刘静, 庄欣, 杜娟, 董春晖. ICU成人患者有创机械通气撤机的最佳证据总结[J]. 护理学报, 2021, 28(6): 27-32.
Viewed
Full text


Abstract

Cited
  Shared   
[1] 马瑞英,李亚洁. 美国疾病诊断相关组法护理支付方式对我国护理收费的启示[J]. 护理学报, 2012, 19(1): 23 -25 .
[2] 周玥,张淼,赵江,李成. 胃肠道肿瘤患者生命质量影响因素研究现状及思考[J]. 护理学报, 2012, 19(1): 26 -28 .
[3] 曾友燕,徐燕,储静,顾申. 护理专业课程实行主讲教师负责制的教学实践与效果分析[J]. 护理学报, 2012, 19(1): 29 -31 .
[4] 谢红燕,杨淑玲. 新型固定沙袋的制作[J]. 护理学报, 2012, 19(1): 31 .
[5] 宁宁,陈佳丽,朱红,马莉. 项目管理理论在医院护理创新管理中的应用[J]. 护理学报, 2012, 19(1): 32 -35 .
[6] 蔡德芳,董云春,李长琼,周媛. 基于护士分管病人的护理绩效考核[J]. 护理学报, 2012, 19(1): 36 -39 .
[7] 汪洋,宋艳玲. 消毒供应中心区域一体式管理控制医院感染的实践[J]. 护理学报, 2012, 19(1): 39 -41 .
[8] 马逊,朱亚梅,吕小林,张静,王蓉花,王玲. 不同血液透析预冲方法对透析器凝血的影响[J]. 护理学报, 2012, 19(1): 42 -44 .
[9] 杨江兰,汤晓丽. 17例新生儿腹裂应用免缝腹裂袋治疗的护理[J]. 护理学报, 2012, 19(1): 48 -50 .
[10] 马婕,魏建华,白茹,雍琪. 1例重度卢德维氏咽峡炎患者的护理[J]. 护理学报, 2012, 19(1): 51 -52 .