Langouche Lies, Vanhorebeek Ilse, Van den Berghe Greet
Katholieke Universiteit Leuven, Belgium.
Nat Clin Pract Endocrinol Metab. 2007 Mar;3(3):270-8. doi: 10.1038/ncpendmet0426.
Hyperglycemia commonly occurs in patients who are acutely ill, in a variety of clinical situations. Generally, moderate hyperglycemia in critically ill patients was thought to be beneficial; however, the degree of hyperglycemia on admission and the duration of hyperglycemia during critical illness are now recognized markers of adverse outcome. The use of insulin therapy to maintain normoglycemia for at least a few days improves survival and reduces morbidity in patients who are in a surgical intensive care unit (ICU), as shown by a large, randomized, controlled study. These results were recently confirmed by two studies--a randomized, controlled study of patients in a medical ICU, and a prospective, observational study of a heterogeneous patient population admitted to a mixed medical and surgical ICU. Results of multicenter trials that investigated tight blood-glucose control in critically ill patients are, however, still lacking. While we await those multicenter results, the current evidence favors the control of blood glucose levels in the ICU. Indeed, the studies showed that many lives are saved with this intervention, despite an increased incidence of hypoglycemia. Prevention of glucose toxicity by strict glycemic control (but also other metabolic and nonmetabolic effects of insulin) contribute to these clinical benefits.
高血糖常见于各种临床情况下的急性病患者。一般来说，危重病患者的中度高血糖曾被认为是有益的；然而，目前入院时的高血糖程度以及危重病期间高血糖的持续时间已被公认为不良预后的标志。一项大型随机对照研究表明，在外科重症监护病房（ICU）中，使用胰岛素治疗至少数天以维持血糖正常可提高生存率并降低发病率。最近两项研究证实了这些结果——一项针对内科ICU患者的随机对照研究，以及一项针对入住内科和外科混合ICU的异质性患者群体的前瞻性观察研究。然而，关于危重病患者严格血糖控制的多中心试验结果仍未得出。在等待这些多中心结果的同时，目前的证据支持在ICU中控制血糖水平。事实上，研究表明，尽管低血糖发生率有所增加，但这种干预措施挽救了许多生命。严格的血糖控制（以及胰岛素的其他代谢和非代谢作用）预防葡萄糖毒性有助于产生这些临床益处。
