Department of Gastroenterological Surgery, Kochi Health Sciences Center, Kochi City, Kochi, Japan.
Curr Opin Clin Nutr Metab Care. 2014 Mar;17(2):190-9. doi: 10.1097/MCO.0000000000000026.
Recent findings suggest that the effects of tight glycemic control (TGC) performing intensive insulin therapy (IIT) in medical and surgical ICU have had conflicting results. The purpose of this review is to summarize the current evidence in humans how closed-loop systems for IIT are ready for prime time in the ICU.
Current evidence suggests that maintaining normoglycemia postoperatively can improve the outcome and reduce the mortality and morbidity of critically ill patients by TGC performing IIT according to the large randomized trials. However, trials examining the effects of TGC have had conflicting results. Systematic reviews and meta-analyses have also led to differing conclusions. The main reason these clinical trials and meta-analyses were negative results for TGC was because of the high incidence of hypoglycemia. This could not be prevented as there is no reliable technique currently able to avoid this condition during IIT. The development of accurate, continuous blood glucose monitoring devices, and closed-loop systems for computer-assisted blood glucose control in the ICU, will probably help avoid hypoglycemia in these situations.
The challenge in the hospital setting demonstrated that a closed-loop glycemic control system is expected to the achievement of TGC with no occurrence of hypoglycemia induced by IIT after surgery. Closed-loop glycemic control systems for IIT are now ready for prime time in the ICU.
最近的研究结果表明，强化胰岛素治疗（IIT）实施严格血糖控制（TGC）在医疗和外科重症监护病房的效果存在相互矛盾的结果。本综述的目的是总结目前关于闭环胰岛素输注系统在 ICU 中是否已经成熟的证据。
根据大型随机试验，术后维持正常血糖水平可以改善危重病患者的预后，降低死亡率和发病率，从而实现 TGC 实施 IIT。然而，检查 TGC 效果的试验结果却相互矛盾。系统评价和荟萃分析也得出了不同的结论。这些临床试验和荟萃分析对 TGC 结果为阴性的主要原因是低血糖的发生率高。由于目前尚无可靠的技术能够在 IIT 期间避免这种情况，因此无法预防低血糖。在 ICU 中，开发准确、连续的血糖监测设备和用于计算机辅助血糖控制的闭环系统，可能有助于避免这些情况下的低血糖。
医院环境中的挑战表明，闭环血糖控制系统有望在术后 IIT 期间实现 TGC 且不发生低血糖。闭环胰岛素输注系统现在已经准备好在 ICU 中投入使用。
