Department of Anesthesiology, Gunma University Hospital, Japan.
Minerva Anestesiol. 2012 May;78(5):574-95. Epub 2012 Feb 10.
Extensive data have shown that acute hyperglycemia is commonly present in the perioperative period among patients undergoing surgery or with critical illness, and a direct relationship between perioperative hyperglycemia and mortality has been established. An outstanding trial by Van den Berghe showed that intensive insulin therapy (IIT) (target blood glucose, 80-110 mg/dL) reduced in-hospital mortality. However, recent large trials have questioned the efficacy and safety of IIT and raised concerns about increased mortality rates due to hypoglycemia. This review focused on how anesthetic agents and techniques, fluid management and preoperative oral intake would affect glucose metabolism and insulin resistance, in addition to recent controversial effects of IIT on improved mortality rate. Anesthesiologists should pay attention not only to the efficacy and risks of IIT during the perioperative period, but also to effects of fluid management, anesthetic agents and techniques during anesthesia on glucose homeostasis.
大量数据表明，手术或患有危重病的患者在围手术期通常会出现急性高血糖，围手术期高血糖与死亡率之间存在直接关系。Van den Berghe 的一项杰出试验表明，强化胰岛素治疗（IIT）（目标血糖，80-110mg/dL）可降低住院死亡率。然而，最近的大型试验对 IIT 的疗效和安全性提出了质疑，并对因低血糖导致的死亡率增加表示担忧。本综述重点讨论了麻醉剂和技术、液体管理和术前口服摄入如何影响葡萄糖代谢和胰岛素抵抗，以及 IIT 对改善死亡率的近期争议性影响。麻醉师不仅应注意围手术期 IIT 的疗效和风险，还应注意麻醉期间液体管理、麻醉剂和技术对葡萄糖稳态的影响。
