Boulkina Lioubov S, Braithwaite Susan S
University of North Carolina, Chapel Hill, NC 27713, USA.
Curr Opin Clin Nutr Metab Care. 2007 Mar;10(2):197-205. doi: 10.1097/MCO.0b013e3280141ff4.
Strategies used for intensive insulin therapy of critically ill patients and differences of approach according to medical condition are reviewed.
Acceptance of proposed glycemic targets for critically ill patients has been tempered by uncertainties about benefit of strict glycemic control for specific target subpopulations, differences between treatment centers, optimal timing and duration of intervention, and safety. Present-day intravenous insulin infusion protocols may perform well only for restricted populations. Assessment of protocol performance requires knowledge of algorithm behavior on or near the narrow target range and, using the patient as unit of observation, examination of glycemic variability. Systems of the future will permit adjustment of algorithm parameters to meet individual- or population-specific targets and match carbohydrate exposure.
Attainment and preservation of glycemic control among critically ill patients are best attempted with intravenous insulin infusion. Advances in the design of decision support and insulin delivery systems, and progress in the technology of continuous blood glucose monitoring, are likely to reduce the risk of hypoglycemia, without compromise of target range control, such that the patient outcomes enjoyed by experienced centers in the future will prove generalizable to others through the extension of new technologies.
回顾危重症患者强化胰岛素治疗所采用的策略以及根据病情不同的治疗方法差异。
对于危重症患者建议的血糖目标，由于特定目标亚群严格血糖控制的益处存在不确定性、治疗中心之间的差异、干预的最佳时机和持续时间以及安全性等问题，其接受度受到了影响。目前的静脉胰岛素输注方案可能仅对特定人群效果良好。评估方案性能需要了解算法在狭窄目标范围内或附近的行为，并以患者为观察单位检查血糖变异性。未来的系统将允许调整算法参数以满足个体或群体特定目标并匹配碳水化合物摄入量。
危重症患者血糖控制的实现和维持最好通过静脉胰岛素输注来尝试。决策支持和胰岛素输送系统设计的进展以及持续血糖监测技术的进步，可能会降低低血糖风险，同时不影响目标范围控制，从而使未来经验丰富的中心所取得的患者治疗效果能够通过新技术的推广应用于其他中心。
