CN112535777A - CGM (China general microbiological culture collection) -based critical patient intelligent blood glucose management system - Google Patents

CGM (China general microbiological culture collection) -based critical patient intelligent blood glucose management system Download PDF

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CN112535777A
CN112535777A CN202011353708.7A CN202011353708A CN112535777A CN 112535777 A CN112535777 A CN 112535777A CN 202011353708 A CN202011353708 A CN 202011353708A CN 112535777 A CN112535777 A CN 112535777A
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insulin
blood glucose
blood sugar
cgm
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CN112535777B (en
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王庆
张瑜
曹超宇
陈虹
窦英茹
朱庆捷
张道周
吴夏鑫
潘明月
唐妍
肖兰兰
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Northern Jiangsu Peoples Hospital
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M5/00—Devices for bringing media into the body in a subcutaneous, intra-vascular or intramuscular way; Accessories therefor, e.g. filling or cleaning devices, arm-rests
    • A61M5/14—Infusion devices, e.g. infusing by gravity; Blood infusion; Accessories therefor
    • A61M5/168—Means for controlling media flow to the body or for metering media to the body, e.g. drip meters, counters ; Monitoring media flow to the body
    • A61M5/172—Means for controlling media flow to the body or for metering media to the body, e.g. drip meters, counters ; Monitoring media flow to the body electrical or electronic
    • A61M5/1723—Means for controlling media flow to the body or for metering media to the body, e.g. drip meters, counters ; Monitoring media flow to the body electrical or electronic using feedback of body parameters, e.g. blood-sugar, pressure
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M2230/00—Measuring parameters of the user
    • A61M2230/20—Blood composition characteristics
    • A61M2230/201—Glucose concentration

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Abstract

The invention discloses an intelligent blood sugar management system for critical patients based on CGM, comprising: the CGM acquisition terminal is used for acquiring the blood sugar value of the patient in real time; the CGM receiving end is used for receiving the collected blood sugar value of the patient; the main control unit is used for analyzing according to the collected blood sugar value of the patient and sending a control signal to the infusion pump unit, the control signal comprises an insulin control signal and a nutrient solution control signal, the infusion pump unit comprises an insulin infusion pump and a nutrient solution infusion pump, the insulin control signal comprises a blood sugar value processing signal, an initial regulation signal and a real-time regulation signal, and mapping data corresponding to the control signal is arranged in the main control unit; the infusion pump unit is used for infusing insulin and nutrient solution to the patient according to the received control signal, and the invention can effectively improve the precision and the safety of blood sugar management of critical patients.

Description

CGM (China general microbiological culture collection) -based critical patient intelligent blood glucose management system
Technical Field
The invention relates to a blood sugar management system, in particular to an intelligent blood sugar management system for critical patients based on CGM.
Background
The incidence of hyperglycemia of critically ill patients during hospitalization is as high as 80%, and hyperglycemia causes disorder of water, electrolyte and acid-base balance of patients, damages cardiac muscle, brain and liver tissues, increases infection risk of patients, and leads to increase of complication incidence and mortality, prolongation of hospitalization time and increase of nursing requirements after discharge. The blood sugar management of critically ill patients becomes an important content in the management of critically ill patients. Effective blood glucose management requires the assistance of accurate blood glucose monitoring and a normative and scientific insulin infusion protocol.
At present, clinically, the blood sugar level of critically ill patients is maintained within a proper range by adjusting and controlling the blood sugar level according to a paper-edition blood sugar infusion scheme after the bedside rapid blood sugar detection. Blood glucose management in critically ill patients is complex involving several sequential steps, each of which involves a possible source of variability, a series of factors that make it difficult to achieve tight control of blood glucose in critically ill patients.
Foreign studies have shown that CGM in combination with an effective insulin infusion regimen can minimize blood glucose excursions, help improve patient outcomes, and reduce nurse workload. The existing critical patient insulin infusion rate adjusting software abroad comprises GlucoCare, GRIP, eMPC and the like, but information such as a patient blood sugar control target, a blood sugar monitoring value and the like needs to be additionally provided, so that intelligent management cannot be performed, and no research and report aiming at a critical patient blood sugar management system exists in China.
The invention designs an intelligent blood sugar management system with a plurality of precise algorithm controls by combining UPMC, yale and Portland insulin treatment schemes so as to achieve precise regulation and control of insulin and intelligent management of blood sugar of critical patients, thereby achieving strict control of the blood sugar of the critical patients. The blood sugar fluctuation and the occurrence of hypoglycemia of critical patients are reduced to the maximum extent, the outcome of the patients is improved, and the workload of nurses is reduced.
Disclosure of Invention
The invention aims to provide an intelligent blood sugar management system for critical patients based on CGM (China general microbiological culture collection) and improve the accuracy and safety of blood sugar management.
The purpose of the invention is realized as follows: a CGM-based critical patient intelligent blood sugar management system comprises:
the CGM acquisition terminal is used for acquiring the blood sugar value of the patient in real time;
the CGM receiving end is used for receiving the collected blood sugar value of the patient and sending the blood sugar value to the main control unit;
the infusion pump unit comprises an insulin infusion pump and a nutrient solution infusion pump, the insulin control signal comprises a blood sugar value processing signal, an initial regulation and control signal and a real-time regulation and control signal, the insulin infusion pump is used for firstly carrying out instant injection amount fast infusion of the initial infusion pump according to the initial regulation and control signal, slowly infusing insulin according to a set injection speed and then selecting an injection scheme according to the real-time regulation and control signal, and mapping data corresponding to the control signal is arranged in the main control unit;
and an infusion pump unit for infusing insulin and nutrient solution to the patient according to the received control signal.
As a further limitation of the present invention, the mapping data of the blood glucose level processing signal is specifically:
Figure BDA0002802006180000021
wherein, BGtFor real-time blood glucose values, BG0The blood sugar value needing insulin pumping is initially detected; the mapping data of the initial regulation signal is specifically:
Figure BDA0002802006180000031
Figure BDA0002802006180000032
Figure BDA0002802006180000033
Figure BDA0002802006180000034
wherein, U0For initial infusion pump bolus rate, UL0Is the initial infusion pump immediate infusion volume, C is the insulin volume in the insulin infusion pump, V is the solvent volume, u is the insulin infusion unit, D0For insulin bolus rate, DL0Is a bolus amount of insulin; this definition can further improve the control accuracy.
As a further limitation of the present invention, the mapping data of the real-time control signal specifically includes:
Figure BDA0002802006180000035
Figure BDA0002802006180000041
BGΔ＝BGs-BGt；
wherein, UtFor adjusting the speed of the post-infusion pump bolus, DsThe insulin bolus rate, D, was set 15min beforetTo adjust the post-insulin infusion rate, DΔFor the variation of the insulin infusion rate, BGsBlood glucose value before 15min, BGΔThe blood sugar change value, and the definition can further improve the control precision.
As a further limitation of the present invention, the mapping data of the nutrient solution control signal is specifically;
Figure BDA0002802006180000042
wherein Ue is the injection speed of the patient after the intervention of the nutrition support insulin, Q is the total amount of glucose in the nutrient solution of the patient, E is the total amount of the nutrient solution, and I is the initial pumping speed of the nutrient solution; and the nutrient solution is pumped in after receiving the instruction of pumping insulin, and the limitation is also used for improving the control precision.
As a further limitation of the present invention, the system calculates the real-time insulin bolus rate UtWhen the blood glucose value is 0, the system automatically identifies and sends an 'insulin pumping stopping' instruction, continues to adopt the real-time CGM receiving end to collect the blood glucose, and receives the real-time blood glucose value BG sent by the CGM collecting endtAnalyzing the blood sugar value, and restarting the initial blood sugar value identification and recording the initial regulation and control signal; system set maximum insulin infusion dose Dmax＝20u/h，0≤Dt≤Dmax(ii) a Maximum insulin bolus DLmax＝10u，0≤DL0≤DLmax。
As a further limitation of the present invention, the main control unit further performs data statistics and analysis to obtain values of blood glucose standard reaching time, blood glucose standard deviation SD, blood glucose variation coefficient CV, average blood glucose fluctuation amplitude MAGE, etc., for evaluating a blood glucose variation adjustment treatment scheme of a patient and providing nutrition guidance.
Compared with the prior art, the invention has the beneficial effects that: the novel patent of the invention achieves the accurate regulation and control of insulin and the intelligent management of the blood sugar of the critical patient through the control of a plurality of precise algorithms, thereby achieving the strict blood sugar control of the critical patient, reducing the blood sugar fluctuation and the occurrence of hypoglycemia of the critical patient to the maximum extent, improving the outcome of the patient and reducing the workload of nurses.
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Fig. 1 is a control schematic block diagram of the present invention.
Detailed Description
Fig. 1 shows an intelligent CGM-based blood glucose management system for critically ill patients, which comprises:
the CGM acquisition terminal is used for acquiring the blood sugar of a patient in real time and uploading the blood sugar once every 5 min;
the CGM receiving end is used for receiving the collected blood sugar value of the patient and sending the blood sugar value to the main control unit so as to continuously monitor the blood sugar change of the patient;
the infusion pump unit comprises an insulin infusion pump and a nutrient solution infusion pump, the insulin control signal comprises a blood sugar value processing signal, an initial regulation signal and a real-time regulation signal, the insulin infusion pump is used for carrying out instant bolus injection and rapid infusion of the initial infusion pump according to the initial regulation signal, slowly infusing the insulin according to a set bolus injection speed, and selecting an injection scheme according to the real-time regulation signal, and mapping data corresponding to the control signal is arranged in the main control unit;
and the infusion pump unit is used for infusing insulin and nutrient solution into the patient according to the received control signal.
The mapping data of the blood glucose value processing signal in the main control unit is specifically as follows:
Figure BDA0002802006180000061
wherein, BGtFor real-time blood glucose values, BG0The blood sugar value needing insulin pumping is initially detected; the invention provides the real-time blood sugar value information of the patient in real time through the accurate blood sugar monitoring of the CGM acquisition terminalAnd after the blood glucose value is analyzed by the main control unit, the blood glucose value processing signal is sent in real time to effectively process the blood glucose value of the patient, so that the instantaneity and the fineness of blood glucose management of critical patients are effectively improved.
The mapping data of the initial regulation signal is specifically as follows:
Figure BDA0002802006180000062
Figure BDA0002802006180000063
Figure BDA0002802006180000064
Figure BDA0002802006180000065
wherein, U0For initial infusion pump bolus rate, UL0Is the initial infusion pump immediate infusion volume, C is the insulin volume in the insulin infusion pump, V is the solvent volume, u is the insulin infusion unit, D0For insulin bolus rate, DL0Is a bolus dose of insulin. According to the invention, a scientific and standardized insulin initial infusion scheme is provided for a patient through mapping data of the insulin initial regulation and control signal, the blood sugar value of the patient is adjusted in time, the water, electrolyte and acid-base balance disorder of critically ill patients caused by stress hyperglycemia is reduced, the damage to cardiac muscle, brain and liver tissues is avoided, the risk of infection is reduced, the occurrence of complications is reduced, the hospitalization time of the patient is shortened, and the like.
The mapping data of the real-time regulation and control signal in the main control unit is specifically as follows:
Figure BDA0002802006180000071
Figure BDA0002802006180000072
BGΔ＝BGs-BGt；
wherein, UtFor adjusting the speed of the post-infusion pump bolus, DsThe insulin bolus rate, D, was set 15min beforetTo adjust the post-insulin infusion rate, DΔFor the variation of the insulin infusion rate, BGsBlood glucose value before 15min, BGΔBlood glucose change value. According to the invention, the mapping data of the real-time insulin regulation and control signal is used as a safe and efficient insulin infusion scheme for the patient, and personalized and intelligent real-time regulation and control are carried out on the real-time blood sugar value of the patient, so that the blood sugar fluctuation of critical patients is better controlled, the occurrence of hypoglycemia is reduced, and the occurrence of nursing error events is avoided.
The mapping data of the nutrient solution control signal in the main control unit is concretely;
Figure BDA0002802006180000081
wherein Ue is the injection speed of the patient after the intervention of the nutrition support insulin, Q is the total amount of glucose in the nutrient solution of the patient, E is the total amount of the nutrient solution, and I is the initial pumping speed of the nutrient solution; and the relative stability of nutrition and blood sugar is ensured after the instruction of pumping insulin is received. The invention provides a targeted insulin intervention scheme based on the nutritional support of patient infusion by mapping data of the nutrient solution control signal, predictively processes the influence of the nutrient solution on the blood sugar of critically ill patients, avoids the occurrence of hyperglycemia and reduces the blood sugar fluctuation of the patients.
The current system in the main control unit calculates the real-time insulin bolus speed UtWhen the blood glucose value is 0, the system automatically identifies and sends an 'insulin pumping stopping' instruction, continues to adopt the real-time CGM receiving end to collect the blood glucose, and receives the real-time blood glucose value BG sent by the CGM collecting endtAnalyzing the blood sugar value, and restarting the initial blood sugar value identification and recording the initial regulation and control signal; system setting is the mostLarge insulin infusion dose Dmax＝20u/h，0≤Dt≤Dmax(ii) a Maximum insulin bolus DLmax＝10u，0≤DL0≤DLmax. According to the invention, the insulin pumping of the patient is stopped in time through the instruction of 'stopping insulin pumping', so that the occurrence of hypoglycemia of the patient is avoided, meanwhile, the real-time blood sugar value of the patient is continuously collected, the blood sugar change of the patient is continuously monitored, and the real-time blood sugar value of the patient is analyzed in time to send out a blood sugar value processing signal so as to form blood sugar closed-loop management of the critically ill patient. In addition, the insulin pump-in of the critically ill patients usually adopts ultra-short-acting insulin, such as insulin aspart and insulin lispro. The ultra-short-acting insulin has quick response and short duration, and is easy to cause hypoglycemia of a patient.
The main control unit also carries out data statistical analysis to obtain values such as blood sugar standard time, blood sugar standard deviation SD, blood sugar variation coefficient CV, average blood sugar fluctuation amplitude MAGE and the like, and the values are used for evaluating blood sugar variation of patients, adjusting treatment schemes and providing nutrition guidance. According to the invention, the data statistics and analysis are carried out on the blood sugar value of the patient through the main control unit, the blood sugar condition of the patient is analyzed from multiple angles, and a personalized insulin infusion scheme is formulated, so that the intelligent and accurate management of the blood sugar value of the critically ill patient is realized, and a theoretical and practical basis is provided for the clinical application of the intelligent blood sugar management system of the critically ill patient.
The present invention is not limited to the above-mentioned embodiments, and based on the technical solutions disclosed in the present invention, those skilled in the art can make some substitutions and modifications to some technical features without creative efforts according to the disclosed technical contents, and these substitutions and modifications are all within the protection scope of the present invention.

Claims (6)

1. A CGM-based critical patient intelligent blood sugar management system is characterized by comprising:
the CGM acquisition terminal is used for acquiring the blood sugar value of the patient in real time;
the CGM receiving end is used for receiving the collected blood sugar value of the patient and sending the blood sugar value to the main control unit;
the infusion control system comprises a main control unit, an infusion pump unit and an infusion control unit, wherein the main control unit is used for analyzing according to the collected blood sugar value of a patient and sending a control signal to the infusion pump unit, the control signal comprises an insulin control signal and a nutrient solution control signal, the infusion pump unit comprises an insulin infusion pump and a nutrient solution infusion pump, the insulin control signal comprises a blood sugar value processing signal, an initial regulation signal and a real-time regulation signal, the insulin infusion pump is used for firstly carrying out instant bolus injection and rapid infusion of the initial infusion pump according to the initial regulation signal, slowly infusing insulin according to a set bolus injection speed, and then selecting an infusion scheme according to the real-time regulation signal, and mapping data corresponding to the control signal are arranged in the main control unit;
and an infusion pump unit for infusing insulin and nutrient solution to the patient according to the received control signal.
2. The CGM-based critically ill patient intelligent blood glucose management system according to claim 1, wherein the mapping data of the blood glucose value processing signal is specifically:
Figure FDA0002802006170000011
wherein, BGtFor real-time blood glucose values, BG0The blood sugar value needing insulin pumping is initially detected;
the mapping data of the initial regulation signal is specifically:
Figure FDA0002802006170000012
Figure FDA0002802006170000013
Figure FDA0002802006170000021
Figure FDA0002802006170000022
wherein, U0For initial infusion pump bolus rate, UL0Is the initial infusion pump immediate infusion volume, C is the insulin volume in the insulin infusion pump, V is the solvent volume, u is the insulin infusion unit, D0For insulin bolus rate, DL0Is a bolus dose of insulin.
3. The CGM-based critically ill patient intelligent blood glucose management system according to claim 2, wherein the mapping data of the real-time regulation and control signal is specifically:
Figure FDA0002802006170000023
Figure FDA0002802006170000024
BGΔ＝BGs-BGt；
wherein, UtFor adjusting the speed of the post-infusion pump bolus, DsThe insulin bolus rate, D, was set 15min beforetTo adjust the post-insulin infusion rate, DΔFor the variation of the insulin infusion rate, BGsBlood glucose value before 15min, BGΔBlood glucose change value.
4. The CGM-based critically ill patient intelligent blood glucose management system according to claim 3, wherein the mapping data of the nutrient solution control signal is specifically;
Figure FDA0002802006170000031
wherein Ue is the injection speed of the patient after the intervention of the nutrition support insulin, Q is the total amount of glucose in the nutrient solution of the patient, E is the total amount of the nutrient solution, and I is the initial pumping speed of the nutrient solution; and the nutrient solution is pumped after receiving the instruction of pumping insulin.
5. The CGM-based critically ill patient intelligent blood glucose management system according to claim 3, wherein when the system calculates real-time insulin bolus rate UtWhen the blood glucose value is 0, the system automatically identifies and sends an 'insulin pumping stopping' instruction, continues to adopt the real-time CGM receiving end to collect the blood glucose value and receives the real-time blood glucose value BG sent by the CGM collecting endtAnalyzing the blood sugar value, and restarting the initial blood sugar value identification and recording the initial regulation and control signal; in addition the system sets the maximum insulin infusion dose Dmax＝20u/h，0≤Dt≤Dmax(ii) a Maximum insulin bolus DLmax＝10u，0≤DL0≤DLmax。
6. The CGM-based intelligent blood glucose management system for critically ill patients according to claim 3, wherein the main control unit further performs data statistical analysis to obtain values of blood glucose standard time, blood glucose standard deviation SD, blood glucose variation coefficient CV, mean blood glucose fluctuation amplitude MAGE, etc. for evaluating blood glucose variation of patients to adjust treatment schemes and provide nutrition guidance.
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Cited By (1)

* Cited by examiner, † Cited by third party
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CN115337502A (en) * 2022-09-20 2022-11-15 青岛海诺生物工程有限公司 Blood glucose monitoring and controlling system and blood glucose monitoring and controlling method

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CN106860955A (en) * 2017-01-21 2017-06-20 广东食品药品职业学院 Method based on fuzzy self-adaption proportional integral derivative control insulin pump closed loop infusion
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CN115337502A (en) * 2022-09-20 2022-11-15 青岛海诺生物工程有限公司 Blood glucose monitoring and controlling system and blood glucose monitoring and controlling method
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