Faustino E Vincent S, Hirshberg Eliotte L, Bogue Clifford W
Yale University School of Medicine, New Haven, Connecticut 06520, USA.
J Diabetes Sci Technol. 2012 Jan 1;6(1):48-57. doi: 10.1177/193229681200600107.
The practice of glycemic control with intravenous insulin in critically ill patients has brought clinical focus on understanding the effects of hypoglycemia, especially in children. Very little is published on the impact of hypoglycemia in this population. We aimed to review the existing literature on hypoglycemia in critically ill neonates and children.
We performed a systematic review of the literature up to August 2011 using PubMed, Ovid MEDLINE and ISI Web of Science using the search terms "hypoglycemia or hypoglyc*" and "critical care or intensive care or critical illness". Articles were limited to "all child (0-18 years old)" and "English".
A total of 513 articles were identified and 132 were included for review. Hypoglycemia is a significant concern among pediatric and neonatal intensivists. Its definition is complicated by the use of a biochemical measure (i.e., blood glucose) for a pathophysiologic problem (i.e., neuroglycopenia). Based on associated outcomes, we suggest defining hypoglycemia as <40-45 mg/dl in neonates and <60-65 mg/dl in children. Below the suggested threshold values, hypoglycemia is associated with worse neurological outcomes, increased intensive care unit stay, and increased mortality. Disruptions in carbohydrate metabolism increase the risk of hypoglycemia incritically ill children. Prevention of hypoglycemia, especially in the setting of intravenous insulin use, will be best accomplished by the combination of accurate measuring techniques, frequent or continuous glucose monitoring, and computerized insulin titration protocols.
Studies on hypoglycemia in critically ill children have focused on spontaneous hypoglycemia. With the current practice of maintaining blood glucose within a narrow range with intravenous insulin, the risk factors and outcomes associated with insulin-induced hypoglycemia should be rigorously studied to prevent hypoglycemia and potentially improve outcomes of critically ill children.
在危重症患者中使用静脉胰岛素进行血糖控制的做法已使临床重点关注低血糖的影响，尤其是在儿童中。关于低血糖对这一人群影响的文献报道极少。我们旨在综述有关危重症新生儿和儿童低血糖的现有文献。
我们使用PubMed、Ovid MEDLINE和ISI Web of Science对截至2011年8月的文献进行了系统综述，搜索词为“低血糖或低血糖症*”以及“危重症护理或重症监护或危重病”。文章限于“所有儿童（0至18岁）”且为“英文”。
共识别出513篇文章，其中132篇纳入综述。低血糖是儿科和新生儿重症监护医生极为关注的问题。其定义因将生化指标（即血糖）用于病理生理问题（即脑葡萄糖利用障碍）而变得复杂。基于相关结局，我们建议将新生儿低血糖定义为血糖<40 - 45mg/dl，儿童低血糖定义为血糖<60 - 65mg/dl。低于建议阈值时，低血糖与更差的神经学结局、重症监护病房住院时间延长及死亡率增加相关。碳水化合物代谢紊乱会增加危重症儿童发生低血糖的风险。预防低血糖，尤其是在使用静脉胰岛素的情况下，最好通过准确的测量技术、频繁或持续的血糖监测以及计算机化胰岛素滴定方案相结合来实现。
关于危重症儿童低血糖的研究主要集中在自发性低血糖。鉴于目前使用静脉胰岛素将血糖维持在狭窄范围内的做法，应严格研究与胰岛素诱导的低血糖相关的危险因素和结局，以预防低血糖并可能改善危重症儿童的结局。
