Egi Moritoki, Bellomo Rinaldo
Department of Anesthesiology and Resuscitology, Okayama University Hospital, Shikata, Okayama, Japan.
J Diabetes Sci Technol. 2009 Nov 1;3(6):1302-8. doi: 10.1177/193229680900300610.
Acute hyperglycemia is common in critically ill patients. Strict control of blood glucose (BG) concentration has been considered important because hyperglycemia is associated independently with increased intensive care unit mortality. After intensive insulin therapy was reported to reduce mortality in selected surgical critically ill patients, lowering of BG levels was recommended as a means of improving patient outcomes. However, a large multicenter multination study has found that intensive insulin therapy increased mortality significantly. A difference in variability of BG control may be one possible explanation why the effect of intensive insulin therapy varied from beneficial to harmful. Several studies have confirmed significant associations between variability of BG levels and patient outcomes. Decreasing the variability of the BG concentration may be an important dimension of glucose management. If reducing swings in the BG concentration is a major biologic mechanism behind the putative benefits of glucose control, it may not be necessary to pursue lower glucose levels with their attendant risk of hypoglycemia.
急性高血糖在重症患者中很常见。严格控制血糖（BG）浓度被认为很重要，因为高血糖与重症监护病房死亡率增加独立相关。在有报道称强化胰岛素治疗可降低特定外科重症患者的死亡率后，建议降低BG水平作为改善患者预后的一种手段。然而，一项大型多中心多国研究发现，强化胰岛素治疗显著增加了死亡率。BG控制变异性的差异可能是强化胰岛素治疗效果从有益变为有害的一个可能解释。几项研究证实了BG水平变异性与患者预后之间存在显著关联。降低BG浓度的变异性可能是血糖管理的一个重要方面。如果降低BG浓度波动是血糖控制假定益处背后的主要生物学机制，那么可能没有必要追求更低的血糖水平及其伴随的低血糖风险。
