摘要
目的探索住院糖尿病患者低血糖的主动监测策略及其临床症状特征和影响因素。方法回顾性检索2023年某三甲医院全部住院患者,通过患者住院号手工检索医院电子病历系统,纳入发生低血糖的成年住院糖尿病患者作为研究对象,收集患者资料,包括一般情况和可能的低血糖相关危险因素。在中国医院药物警戒系统(CHPS)嵌入低血糖电子触发器程序,审查触发器触发阳性患者的原始病历,计算触发器的阳性预测值(PPV)。从国家不良反应监测系统中搜索同时期本院自发上报的低血糖不良反应例数,和实际发现的低血糖例数进行比对。根据可疑药物性低血糖患者是否出现低血糖相关症状分为有症状组与无症状组,应用多因素logistic回归法分析其影响因素。结果研究共纳入1001例出现低血糖的成年住院糖尿病患者,其中可疑药物性低血糖患者725例,可疑药物相互作用导致的低血糖有495例,经人工审查,药物性低血糖患者中有临床症状的有131例次,应上报低血糖不良反应事件,该触发器对有症状低血糖的PPV为18.1%(131/725)。而从国家不良事件监测系统中搜索同时期本院自发上报的低血糖不良反应例数为4例次,上报率仅3.1%(4/131)。logistic多因素回归分析结果显示,年龄增长、2级低血糖是可疑药物性低血糖患者出现相关症状的危险因素(P<0.05),外科、2型糖尿病和未分型糖尿病、服用胰岛素促泌剂则是保护因素(P<0.05)。结论药物性低血糖在住院糖尿病患者低血糖中占主导地位,且年龄、低血糖分级、使用胰岛素促泌剂、住院科室、糖尿病诊断分型与临床低血糖相关症状的出现密切相关。通过CHPS系统进行主动监测,可以有效提高住院糖尿病患者低血糖不良事件的检出率和上报率。
Objective To explore the active monitoring strategies for hypoglycemia in hospitalized diabetic patients,as well as their clinical symptom characteristics and influencing factors.Methods A retrospective search was conducted on all inpatients in a tertiary hospital in 2023.The hospital’s electronic medical record system was manually retrieved through the inpatient numbers of the patients.Adult inpatients with diabetes who experienced hypoglycemia were included as the research subjects,and the general conditions and possible hypoglycemia-related risk factors were collected.Embed the hypoglycemic electronic trigger program in China Hospital Pharmacovigilance System(CHPS),reviewed the original medical records of patients with positive trigger triggering,and calculated the positive predictive value(PPV).Searched for the number of hypoglycemic adverse reaction cases voluntarily reported by this hospital during the same period from National Adverse Reaction Monitoring System and compared with the actual number of hypoglycemic cases discovered.Patients with suspected drug-induced hypoglycemia were divided into the symptomatic group and the asymptomatic group based on whether they presented hypoglycemia-related symptoms.Multivariate logistic regression analysis was applied to analyze the influencing factors.Results A total of 1001 adult hospitalized diabetic patients with hypoglycemia were included in the study.Among them,725 cases were suspected of drug-induced hypoglycemia,and 495 cases were suspected of hypoglycemia caused by drug interactions.After manual review,131 cases of drug-induced hypoglycemia patients had clinical symptoms,and hypoglycemic adverse reaction events should be reported,PPV of this trigger for symptomatic hypoglycemia was 18.1%(131/725).However,the number of hypoglycemic adverse reactions spontaneously reported through National Adverse Reaction Monitoring System by this hospital during the same period was 4 cases,and the reporting rate was only 3.1%(4/131).Multivariate logistic regression analysis showed that aging and grade 2 hypoglycemia were risk factors for the occurrence of related symptoms in patients with suspected drug-induced hypoglycemia(P<0.05),while surgery,type 2 glucosuria,unclassified diabetes,and the use of insulin secretagogues were protective factors(P<0.05).Conclusion Drug-induced hypoglycemia dominates among hospitalized diabetic patients,and age,hypoglycemia grade,inpatient department using insulin secretagogues,diabetes diagnosis and classification are closely related to the occurrence of clinical hypoglycemia-related symptoms.Active monitoring through CHPS can effectively increase the detection rate and reporting rate of hypoglycemic adverse events in hospitalized diabetic patients.
作者
林璐
詹陆川
张舒婷
李泳洁
张晓娟
王来友
赖伟华
LIN Lu;ZHAN Luchuan;ZHANG Shuting;LI Yongjie;ZHANG Xiaojuan;WANG Laiyou;LAI Weihua(Department of Pharmacy,Guangdong Provincial People’s Hospital Affiliated to Southern Medical University/Guangdong Academy of Medical Sciences,Guangzhou,Guangdong 510080,China;Department of Endocrinology,Guangdong Provincial People’s Hospital Affiliated to Southern Medical University/Guangdong Academy of Medical Sciences,Guangzhou,Guangdong 510080,China;School of Biological Science and Engineering,South China University of Technology,Guangzhou,Guangdong 510006,China)
出处
《重庆医学》
2025年第8期1870-1876,1882,共8页
Chongqing Medical Journal
基金
广东省医院药学研究基金项目(2022A13)
广东省医院协学药学科研专项基金项目(2021YSQN)。
关键词
住院患者
糖尿病
低血糖
不良事件
主动监测
inpatient
diabetes hypoglycemia
adverse events
active monitoring
