Mowery Nathan T, Dortch Marcus J, Dossett Lesly A, Norris Patrick R, Diaz Jose J, Morris John A, May Addison K
Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
J Intensive Care Med. 2009 Jul-Aug;24(4):242-51. doi: 10.1177/0885066609335663. Epub 2009 Jul 17.
The hyperglycemic state following trauma and surgery is related partially to insulin resistance (IR). The objective is to determine if critically ill surgical patients vary in their extent of IR and is IR associated with mortality.
Prospective observational study in trauma and surgical intensive care units. There were 925 ventilated, critically ill surgical patients who were placed on an automated euglycemia protocol. A mathematic multiplier (M) employed by the protocol was used as a measure of IR. Outcome, phenotypic, laboratory, and treatment variables were analyzed.
54,141 entries for glucose (mg/dl) and M were analyzed. Median glucose was 118mg/dL, with 45% of values between 80-110mg/dL, 81% between 80-150 mg/dL, and 0.2% less than 40 mg/ dL. M varied by 42 fold over the entire population, and by an average of 11-fold among individual patients. The median blood glucose was not different between groups (118 mg/dl for survivors and 118 mg/dl for non-survivors, P = 0.36). The median insulin dose and M were significantly higher in non-survivors (4.1 U/hr versus 3.4 U/hr, P = 0.005; 0.061 versus 0.058, P = 0.02).
There was a large amount of variation in insulin resistance, as measured by an adapting multiplier, both across the population and within patients. In the setting of tight glucose control measures of glucose control (median blood glucose and percent in range) do not differentiate between patients who lived and died while measures of insulin resistance (median insulin dose and multiplier) do, suggesting that the insulin resistance is a better predictor of outcome.
创伤和手术后的高血糖状态部分与胰岛素抵抗（IR）有关。目的是确定重症外科患者的胰岛素抵抗程度是否存在差异，以及胰岛素抵抗是否与死亡率相关。
在创伤和外科重症监护病房进行前瞻性观察研究。925名接受机械通气的重症外科患者采用自动血糖正常化方案。该方案使用的数学乘数（M）用作胰岛素抵抗的指标。分析了结局、表型、实验室和治疗变量。
分析了54141条葡萄糖（mg/dl）和M的数据记录。血糖中位数为118mg/dL，45%的值在80 - 110mg/dL之间，81%在80 - 150mg/dL之间，0.2%低于40mg/dL。M在整个人口中变化42倍，个体患者平均变化11倍。两组之间的血糖中位数无差异（幸存者为118mg/dl，非幸存者为118mg/dl，P = 0.36）。非幸存者的胰岛素剂量中位数和M显著更高（4.1 U/小时对3.4 U/小时，P = 0.005；0.061对0.058，P = 0.02）。
通过适应性乘数测量，胰岛素抵抗在人群和患者个体中均存在大量差异。在严格血糖控制措施下，血糖控制指标（血糖中位数和达标百分比）无法区分存活和死亡患者，而胰岛素抵抗指标（胰岛素剂量中位数和乘数）可以，这表明胰岛素抵抗是更好的预后预测指标。
