Bilotta Federico, Rosa Giovanni
Crit Care. 2012 Oct 30;16(5):163. doi: 10.1186/cc11521.
Currently, the major issue in glycemic control in neurocritical care patients is that tight glycemic control (target range of 80 to 110 mg/dL) using intensive insulin therapy is associated with higher rates of hypoglycemia without an improvement in survival rate. The review by Kramer and colleagues in this issue of Critical Care confirms these data but provides solid evidence about the relationship between hyperglycemia and worsened neurological outcome after acute brain injury. In accordance with the conclusions of Kramer and colleagues, we recommend that a glucose control goal in neurocritical care patients be in the 'moderate' target range (110 to 180 mg/dL). In addition, we recommend adequate nutrition before and during insulin infusion, avoidance of insulin as a bolus, and the use of continuous insulin infusion, beginning with low doses with titration to individual sensitivity. Careful and accurate glycemic monitoring is especially important when insulin is infused.
目前，神经重症监护患者血糖控制的主要问题是，采用强化胰岛素治疗进行严格血糖控制（目标范围为80至110毫克/分升）会导致低血糖发生率更高，且生存率并无改善。Kramer及其同事在本期《重症监护》中的综述证实了这些数据，但提供了关于急性脑损伤后高血糖与神经功能恶化之间关系的确凿证据。根据Kramer及其同事的结论，我们建议神经重症监护患者的血糖控制目标应在“适度”目标范围（110至180毫克/分升）内。此外，我们建议在输注胰岛素之前和期间提供充足营养，避免大剂量推注胰岛素，采用持续胰岛素输注，并从低剂量开始，根据个体敏感性进行滴定。在输注胰岛素时，仔细而准确的血糖监测尤为重要。
