Skeie Svein, Søreide Eldar, Cooper John
Endokrinologisk seksjon, Medisinsk klinikk, Stavanger universitetssjukehus, Postboks 8100, 4068 Stavanger.
Tidsskr Nor Laegeforen. 2007 Sep 20;127(18):2378-81.
Stress, acute illness and surgery are known to increase blood sugar. Hyperglycaemia in critically ill patients is associated with increased mortality irrespective of diabetes status. The effect of treating critically ill patients with insulin infusions has been assessed in many randomised trials in recent years. Possible mechanisms related to hyperglycaemia and the effects of insulin have also been studied.
The present review is based on a systematic Medline search, references in key articles, and our personal clinical experience.
The effect of reducing blood glucose to normal levels is best documented in patients with myocardial infarction and in those receiving intensive care. Insulin therapy should be considered when plasma glucose levels exceed 8 mmol/L; the treatment target is 4-6 mmol/L. There is a low risk of serious hypoglycaemia according to our experience, but systematic monitoring of blood glucose is important.
Insulin therapy is an inexpensive and safe way to improve outcome in critically ill patients. Insulin infusions should therefore be used more to treat hyperglycaemia in critically ill hospitalized patients, especially in coronary care- and intensive care units.
已知压力、急性疾病和手术会使血糖升高。重症患者的高血糖与死亡率增加相关,无论其糖尿病状态如何。近年来,许多随机试验评估了对重症患者输注胰岛素治疗的效果。与高血糖相关的可能机制以及胰岛素的作用也已得到研究。
本综述基于对医学文献数据库(Medline)的系统检索、关键文章中的参考文献以及我们个人的临床经验。
将血糖降至正常水平的效果在心肌梗死患者和接受重症监护的患者中记录最为充分。当血浆葡萄糖水平超过8 mmol/L时应考虑胰岛素治疗;治疗目标为4 - 6 mmol/L。根据我们的经验,严重低血糖风险较低,但系统监测血糖很重要。
胰岛素治疗是改善重症患者预后的一种廉价且安全的方法。因此,应更多地使用胰岛素输注来治疗住院重症患者的高血糖,尤其是在冠心病监护病房和重症监护病房。