Atkins Joshua H, Smith David S
Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
J Diabetes Sci Technol. 2009 Nov 1;3(6):1352-64. doi: 10.1177/193229680900300615.
Significant fluctuations in serum glucose levels accompany the stress response of surgery or acute injury and may be associated with vascular or neurologic morbidity. Maintenance of euglycemia with intensive insulin therapy (IIT) continues to be investigated as a therapeutic intervention to decrease morbidity associated with derangements in glucose metabolism. Hypoglycemia is a common side effect of IIT with potential for significant morbidity, especially in the neurologically injured patient. Differences in cerebral versus systemic glucose metabolism, the time course of cerebral response to injury, and heterogeneity of pathophysiology in neurosurgical patient populations are important to consider in evaluating the risks and benefits of IIT. While extremes of glucose levels are to be avoided, there are little data to support specific use of IIT for maintenance of euglycemia in the perioperative management of neurosurgical patients. Existing data are summarized and reviewed in this context.
血清葡萄糖水平的显著波动伴随着手术或急性损伤的应激反应，并且可能与血管或神经疾病相关。强化胰岛素治疗（IIT）维持血糖正常作为一种治疗干预措施，旨在降低与葡萄糖代谢紊乱相关的发病率，仍在研究中。低血糖是IIT的常见副作用，具有显著发病的可能性，尤其是在神经损伤患者中。在评估IIT的风险和益处时，大脑与全身葡萄糖代谢的差异、大脑对损伤的反应时间进程以及神经外科患者群体病理生理学的异质性是需要考虑的重要因素。虽然应避免血糖水平的极端情况，但几乎没有数据支持在神经外科患者围手术期管理中使用IIT维持血糖正常的具体做法。在此背景下，对现有数据进行了总结和综述。
