Godoy Daniel A, Rabinstein Alejandro, Videtta Walter, Murillo-Cabezas Francisco
Unidad de Cuidados Neurointensivos, Sanatorio Pasteur, Catamarca, Argentina.
Rev Neurol. 2010 Dec 16;51(12):745-56.
To review the most significant studies on the pathophysiology of hypoglycaemia and hyperglycaemia in neurocritical patients and the therapeutic interventions used to control them.
Available evidence shows that hypoglycaemia and hyperglycaemia increase brain injury and aggravate the prognosis, but it fails to establish the most suitable levels of blood glucose. Intensive treatment with insulin, compared with more moderate regimes, has not improved the prognosis and leads to further episodes of hypoglycaemia.
Hypoglycaemia must always be avoided. Intensive treatment to control hyperglycaemia does not offer any kind of advantages and increases the likelihood of hypoglycaemia; it therefore cannot be recommended in neurocritical patients. No evidence is available showing the optimal level of blood glucose or the most suitable insulin regime, although its use is generally indicated when blood glucose levels are higher than 180-200 mg/dL. The value of the pharmacological control of blood glucose levels to improve the prognosis remains uncertain.
回顾关于神经重症患者低血糖和高血糖病理生理学的最重要研究以及用于控制它们的治疗干预措施。
现有证据表明，低血糖和高血糖会增加脑损伤并使预后恶化，但未能确定最合适的血糖水平。与更适度的治疗方案相比，胰岛素强化治疗并未改善预后，反而导致更多低血糖发作。
必须始终避免低血糖。控制高血糖的强化治疗没有任何优势，反而增加了低血糖的可能性；因此，不推荐在神经重症患者中使用。尽管血糖水平高于180 - 200mg/dL时通常会使用胰岛素，但尚无证据表明最佳血糖水平或最合适的胰岛素治疗方案。通过药物控制血糖水平以改善预后的价值仍不确定。
