Blondet Juan Jose, Beilman Greg J
Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA.
Curr Opin Crit Care. 2007 Aug;13(4):421-7. doi: 10.1097/MCC.0b013e32826388a1.
Hyperglycemia is common during perioperative management of surgical and critically ill patients. There is extensive ongoing study of detrimental effects associated with hyperglycemia, with several remaining unanswered questions. This review discusses recent literature on tight glucose control with insulin therapy and its effects in prevention and management of infection.
Hyperglycemia affects multiple pathways of the immune system, resulting in decreased phagocytic and chemotactic functions in neutrophils and monocytes, as well as increased rates of apoptosis of the former and decreased ability of the latter to present antigen. Intensive insulin therapy has been shown to counteract many of these deleterious effects. Clinically, the benefits of tight glucose control have been evaluated in different patient populations with conclusions that remain varied. Hypoglycemia as a complication of tight glucose control continues to be an issue and has led to discontinuation of two large-scale studies. The clinical relevance of hypoglycemic events remains unclear.
Hyperglycemia impairs the cellular immune system, stimulates inflammatory cytokines, and affects the microcirculation, thus increasing risk for infection and preventing normal wound healing. Additional investigation is needed to define appropriate patient populations and to develop effective treatment strategies for preventing perioperative morbidity.
高血糖在外科手术患者及危重症患者的围手术期管理中很常见。目前正在广泛研究与高血糖相关的有害影响，但仍有几个问题尚未得到解答。本综述讨论了近期关于胰岛素治疗严格控制血糖及其在预防和管理感染方面作用的文献。
高血糖影响免疫系统的多个途径，导致中性粒细胞和单核细胞的吞噬及趋化功能降低，前者的凋亡率增加，后者呈递抗原的能力下降。强化胰岛素治疗已被证明可抵消许多这些有害影响。临床上，已在不同患者群体中评估了严格控制血糖的益处，结论各异。低血糖作为严格控制血糖的并发症仍然是一个问题，并导致两项大规模研究终止。低血糖事件的临床相关性仍不清楚。
高血糖损害细胞免疫系统，刺激炎性细胞因子，并影响微循环，从而增加感染风险并阻碍正常伤口愈合。需要进一步研究以确定合适的患者群体，并制定有效的治疗策略以预防围手术期发病。
