Department of Surgery, Kochi Medical School, Kochi University, Kohasu-Okocho, Nankoku, Kochi, 783-8505, Japan.
Surg Today. 2011 Oct;41(10):1344-51. doi: 10.1007/s00595-011-4537-8. Epub 2011 Sep 16.
Strict glycemic control needs to be maintained in critically ill surgical patients to reduce the mortality and morbidity due to hyperglycemia and associated infection. However, conventional intensive insulin therapy (IIT), which consists of intermittent blood glucose measurement and manually controlled infusions of insulin, tends to induce hypoglycemia and glucose variability. Many randomized clinical trials have been conducted to improve the efficacy of IIT, although some of these were stopped owing to frequent hypoglycemia. In pursuing safe and strict glycemic control for critically ill surgical patients, we found that a closed-loop glycemic control system was able to maintain appropriate blood glucose levels without hypoglycemia in more than 400 clinical cases. Considering the need for the perioperative and intensive care environment, a well-established artificial pancreas was modified into a new closed-loop glycemic control system, called the progressive artificial pancreas. The new device is slim in shape and shows clinical compatibility with the conventional artificial pancreas. We herein review this new closed-loop glycemic control system and the expectations for its future application in critically ill surgical patients.
严重外科疾病患者需要严格控制血糖以降低高血糖和相关感染导致的死亡率和发病率。然而，传统的强化胰岛素治疗（IIT）包括间歇性血糖测量和手动控制胰岛素输注，容易导致低血糖和血糖波动。已经进行了许多随机临床试验来提高 IIT 的疗效，尽管其中一些因频繁发生低血糖而停止。在为严重外科疾病患者寻求安全和严格的血糖控制时，我们发现闭环血糖控制系统能够在 400 多例临床病例中维持适当的血糖水平而不发生低血糖。考虑到围手术期和重症监护环境的需要，我们对经过充分验证的人工胰腺进行了修改，开发了一种新的闭环血糖控制系统，称为渐进式人工胰腺。新装置形状小巧，与传统人工胰腺具有临床兼容性。我们在此回顾了这种新的闭环血糖控制系统，并对其在严重外科疾病患者中的未来应用寄予厚望。
