Ulate Kalia P, Raj Shekhar, Rotta Alexandre T
Seattle Children's Hospital, University of Washington, Seattle, Washington, USA.
J Diabetes Sci Technol. 2012 Jan 1;6(1):29-36. doi: 10.1177/193229681200600105.
Critical illness hyperglycemia (CIH) is common in pediatric and adult intensive care units (ICUs). Children undergoing surgical repair or palliation of congenital cardiac defects are particularly at risk for CIH and its occurrence has been associated with increased morbidity and mortality in this population. Strict glycemic control through the use of intensive insulin therapy (IIT) has been shown to improve outcomes in some adult and pediatric studies, yet these findings have sparked controversy. The practice of strict glycemic control has been slow in extending to pediatric ICUs because of the documented increase in the incidence of hypoglycemia in patients treated with IIT. Protocol driven approaches with more liberal glycemic targets have been successfully validated in general and cardiac critical care pediatric patients with low rates of hypoglycemia. It is unknown whether a therapeutic benefit is obtained by keeping patients in this more liberal glycemic control target. Definitive randomized controlled trials of IIT utilizing these targets in critically ill children are ongoing.
危重症高血糖（CIH）在儿科和成人重症监护病房（ICU）中很常见。接受先天性心脏缺陷手术修复或姑息治疗的儿童尤其容易发生CIH，其发生与该人群发病率和死亡率的增加有关。在一些成人和儿科研究中，通过强化胰岛素治疗（IIT）进行严格的血糖控制已被证明可改善预后，但这些发现引发了争议。由于有记录表明接受IIT治疗的患者低血糖发生率增加，严格血糖控制的做法在儿科ICU中的推广一直很缓慢。在一般和心脏重症监护儿科患者中，采用更宽松血糖目标的方案驱动方法已成功得到验证，且低血糖发生率较低。目前尚不清楚将患者维持在这种更宽松的血糖控制目标是否能获得治疗益处。针对危重症儿童使用这些目标进行IIT的确定性随机对照试验正在进行中。
