Brealey David, Singer Mervyn
Bloomsbury Institute of Intensive Care Medicine, University College London, London, United Kingdom.
J Diabetes Sci Technol. 2009 Nov 1;3(6):1250-60. doi: 10.1177/193229680900300604.
Hyperglycemia is commonplace in the critically ill patient and is associated with worse outcomes. It occurs after severe stress (e.g., infection or injury) and results from a combination of increased secretion of catabolic hormones, increased hepatic gluconeogenesis, and resistance to the peripheral and hepatic actions of insulin. The use of carbohydrate-based feeds, glucose containing solutions, and drugs such as epinephrine may exacerbate the hyperglycemia. Mechanisms by which hyperglycemia cause harm are uncertain. Deranged osmolality and blood flow, intracellular acidosis, and enhanced superoxide production have all been implicated. The net result is derangement of endothelial, immune and coagulation function and an association with neuropathy and myopathy. These changes can be prevented, at least in part, by the use of insulin to maintain normoglycemia.
高血糖在危重症患者中很常见，且与更差的预后相关。它发生在严重应激（如感染或损伤）之后，是由分解代谢激素分泌增加、肝糖异生增加以及对胰岛素外周和肝脏作用的抵抗共同导致的。使用碳水化合物类饲料、含葡萄糖溶液以及肾上腺素等药物可能会加重高血糖。高血糖造成损害的机制尚不清楚。渗透压和血流紊乱、细胞内酸中毒以及超氧化物生成增加都与之有关。最终结果是内皮、免疫和凝血功能紊乱，并与神经病变和肌病相关。至少部分地通过使用胰岛素维持血糖正常，这些变化是可以预防的。
