危重病患者的血清葡萄糖浓度控制。
Control of serum glucose concentration in critical illness.
机构信息
Department of Pediatrics, Section of Pediatric Critical Care Medicine, Yale University School of Medicine, New Haven, Connecticut 06520-8064, USA.
出版信息
Curr Opin Pediatr. 2013 Jun;25(3):297-303. doi: 10.1097/MOP.0b013e328360c6a0.
PURPOSE OF REVIEW
Hyperglycemia is a significant problem for children in the ICU. Use of tight glycemic control (TGC) to manage hyperglycemia remains controversial, especially given the potential risk of insulin-induced hypoglycemia. This review will address the latest evidence regarding TGC in critically ill children.
RECENT FINDINGS
Two randomized controlled trials (RCT) involving primarily postoperative cardiac surgery patients demonstrated the feasibility and safety of TGC in pediatric patients. The trials, however, had discrepant results with regards to the benefit of TGC. There is also uncertainty about the generalizability of these results to nonpostoperative cardiac patients. There is only one published study addressing the long-term safety of TGC in children. In this study, hypoglycemia was not associated with adverse effects on neurocognitive development. In contrast, articles from adult studies demonstrate increased risk of death with hypoglycemia.
SUMMARY
Although the clinical benefit of TGC in critically ill children is still unclear, TGC can be done safely in this population.
目的综述
高血糖是 ICU 患儿的一个重大问题。使用严格血糖控制（TGC）来控制高血糖仍然存在争议，特别是考虑到胰岛素引起的低血糖的潜在风险。本综述将讨论有关危重症儿童 TGC 的最新证据。
最近的发现
两项主要涉及心脏手术后患者的随机对照试验（RCT）表明 TGC 在儿科患者中的可行性和安全性。然而，这些试验在 TGC 的益处方面存在结果上的差异。这些结果是否可以推广到非心脏手术后患者也存在不确定性。只有一项关于 TGC 在儿童中长期安全性的已发表研究。在这项研究中，低血糖与神经认知发育不良的不良影响无关。相比之下，来自成人研究的文章表明低血糖与死亡风险增加有关。
总结
尽管 TGC 对危重症儿童的临床益处仍不清楚，但在该人群中可以安全地进行 TGC。
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