Steven James, Nicolson Susan
Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA.
Paediatr Anaesth. 2011 May;21(5):530-7. doi: 10.1111/j.1460-9592.2011.03587.x.
The perioperative management of blood glucose has been controversial since clinical associations between hyperglycemia and adverse outcomes were first reported more than two decades ago. Despite some early evidence supporting a causal relationship between hyperglycemia and adverse outcomes, prospective trials of tight glycemic control have been inconclusive, except in selected populations, like adult diabetics. These trials have consistently reported dramatic increases in the incidence and severity of hypoglycemia, which may also have associated adverse outcomes. Bedside glucose monitors typically used to manage glucose have increasingly been found to introduce systematic inaccuracies. Relevant studies of infants and children undergoing cardiac surgery are considerably fewer in number, requiring clinicians to extrapolate from other clinical conditions and patient populations.
自二十多年前首次报道高血糖与不良结局之间的临床关联以来，围手术期血糖管理一直存在争议。尽管一些早期证据支持高血糖与不良结局之间存在因果关系，但除了特定人群（如成年糖尿病患者）外，严格血糖控制的前瞻性试验尚无定论。这些试验一致报告低血糖的发生率和严重程度显著增加，低血糖也可能伴有不良结局。人们越来越发现，通常用于管理血糖的床边血糖仪会产生系统性误差。接受心脏手术的婴幼儿相关研究数量相当少，这就要求临床医生从其他临床情况和患者群体中进行推断。
