Mebis Liese, Gunst Jan, Langouche Lies, Vanhorebeek Ilse, Van den Berghe Greet
Department of Intensive Care Medicine, Catholic University of Leuven, Leuven, Belgium.
Curr Opin Crit Care. 2007 Aug;13(4):392-8. doi: 10.1097/MCC.0b013e3281c1c9c8.
Two large randomized studies demonstrated that maintenance of normoglycemia with intensive insulin therapy for at least a few days decreases morbidity and mortality of critically ill patients. This review gives an overview of the benefits associated with this therapy and highlights the importance of achieving optimal blood glucose levels. It discusses the indications for this therapy and the fear for potential harm.
A pooled analysis of the two Leuven studies (n = 2748) revealed a significantly reduced morbidity and mortality in critically ill patients for all subgroups, except those with a prior history of diabetes. An absolute reduction in risk of hospital death of 3-4% is to be expected from this therapy in an intention-to-treat analysis. When patients are treated for more than 3 days, the absolute reduction in risk of death increases to approximately 8%. The available data indicate that strict normoglycemia is required to obtain optimal clinical benefit. This increases the risk of hypoglycemia, but it remains unclear whether this is truly harmful in the setting of critical care.
Maintaining strict normoglycemia by the use of intensive insulin therapy improves outcome of critically ill patients.
两项大型随机研究表明，采用强化胰岛素治疗维持血糖正常至少数天可降低重症患者的发病率和死亡率。本综述概述了该治疗方法的益处，并强调了实现最佳血糖水平的重要性。它讨论了该治疗的适应症以及对潜在危害的担忧。
对鲁汶两项研究（n = 2748）的汇总分析显示，除既往有糖尿病病史的患者外，所有亚组的重症患者发病率和死亡率均显著降低。在意向性治疗分析中，预计该治疗可使医院死亡风险绝对降低3 - 4%。当患者治疗超过3天时，死亡风险的绝对降低幅度增加至约8%。现有数据表明，需要严格维持血糖正常才能获得最佳临床益处。这增加了低血糖风险，但在重症监护环境中这是否真的有害仍不清楚。
通过强化胰岛素治疗维持严格的血糖正常可改善重症患者的预后。
