Vanhorebeek Ilse, Langouche Lies, Van den Berghe Greet
Department of Intensive Care Medicine, Katholieke Universiteit, Leuven, Leuven, Belgium.
Endocr Pract. 2006 Jul-Aug;12 Suppl 3:14-22. doi: 10.4158/EP.12.S3.14.
Hyperglycemia is a common feature of the critically ill and has been associated with increased mortality. In this review, we give an overview of studies associating critical illness-induced hyperglycemia with adverse outcome and describe how mortality and morbidity are affected when blood glucose levels are strictly controlled to normoglycemia with intensive insulin therapy.
Maintaining normoglycemia with intensive insulin therapy improves survival rates and reduces morbidity in prolonged critically ill patients in both surgical and medical intensive care units (ICUs), as shown by 2 large randomized controlled studies. Prevention of cellular glucose toxicity by strict glycemic control appears to play a predominant role, but other metabolic and nonmetabolic effects of insulin also seem to contribute to the clinical benefits of this therapy.
These data support the generalized implementation of a strict blood glucose control management with intensive insulin therapy in adult surgical as well as medical ICU patients.
高血糖是危重症患者的常见特征，且与死亡率增加相关。在本综述中，我们概述了将危重症诱发的高血糖与不良结局相关联的研究，并描述了通过强化胰岛素治疗将血糖水平严格控制在正常血糖范围时，死亡率和发病率是如何受到影响的。
两项大型随机对照研究表明，在外科和内科重症监护病房（ICU）中，通过强化胰岛素治疗维持正常血糖可提高长期危重症患者的生存率并降低发病率。严格的血糖控制预防细胞葡萄糖毒性似乎起主要作用，但胰岛素的其他代谢和非代谢作用似乎也有助于该治疗的临床益处。
这些数据支持在成年外科和内科ICU患者中普遍实施强化胰岛素治疗的严格血糖控制管理。
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