Department of Medicine, Section of Pulmonary and Critical Care Medicine, Yale University School of Medicine, New Haven, CT, USA.
J Intensive Care Med. 2011 May-Jun;26(3):135-50. doi: 10.1177/0885066610387892. Epub 2010 Nov 30.
Hyperglycemia is common in critical illness and has been associated with increased morbidity and mortality. An era of tight glucose control began when intensive insulin therapy was shown to improve outcomes in a single-center randomized trial. More recently, with the publication of additional studies, questions have been raised regarding the efficacy and safety of intensive glycemic management. This article will review the biologic mechanisms that may help us understand why and how hyperglycemia and insulin are relevant in critical illness. We will then explore insights gleaned from available clinical trials. Finally, we will discuss specific areas of controversy that relate to the implementation of glycemic control in the intensive care unit, such as the ideal glucose target and the importance of hypoglycemia.
高血糖在危重病中很常见，并与发病率和死亡率的增加有关。当强化胰岛素治疗在一项单中心随机试验中显示出改善结局的效果时，严格血糖控制的时代开始了。最近，随着更多研究的发表，人们对强化血糖管理的疗效和安全性提出了质疑。本文将回顾可能有助于我们理解为什么高血糖和胰岛素在危重病中相关以及如何相关的生物学机制。然后，我们将探讨从现有临床试验中获得的见解。最后，我们将讨论与重症监护病房血糖控制的实施相关的具体争议领域，例如理想的血糖目标和低血糖的重要性。
