Indiana University School of Medicine, 541 Clinical Drive, Indianapolis, IN 46202, USA.
Postgrad Med. 2010 Jan;122(1):153-62. doi: 10.3810/pgm.2010.01.2109.
In non-critical care settings, patients with hyperglycemia experience increased morbidity and mortality. Despite an increased recognition of the importance of treating inpatient hyperglycemia, many patients are still not adequately controlled. Insulin offers flexibility to address varying glucose levels and therefore is the preferred therapy to achieve recommended targets and manage hyperglycemia. Traditional sliding-scale insulin regimens often ineffectively control blood glucose levels as they are unable to mimic physiologic insulin secretion. Basal-bolus insulin regimens are recognized as a more effective way to correct hyperglycemia in non-critical care settings and a systematic glycemic control program is necessary to address hyperglycemia while minimizing hypoglycemia. Critical components of these programs include addressing barriers to glycemic control, understanding varying needs of different types of patients, and developing standardized subcutaneous insulin orders to achieve target glucose levels. This article provides strategies for using insulin in non-critical care settings to facilitate glycemic control.
在非重症监护环境中，高血糖患者的发病率和死亡率会增加。尽管人们越来越认识到治疗住院患者高血糖的重要性，但许多患者的血糖仍未得到充分控制。胰岛素具有灵活调整血糖水平的优势，因此是实现推荐目标和管理高血糖的首选治疗方法。传统的胰岛素推注方案往往无法有效控制血糖水平，因为它们无法模拟生理胰岛素分泌。基础-餐时胰岛素方案被认为是在非重症监护环境中纠正高血糖的更有效方法，需要制定系统的血糖控制方案来控制高血糖，同时尽量减少低血糖的发生。这些方案的关键组成部分包括解决血糖控制障碍、了解不同类型患者的不同需求，以及制定标准化的皮下胰岛素医嘱以达到目标血糖水平。本文提供了在非重症监护环境中使用胰岛素来促进血糖控制的策略。
