Krinsley James S
Director of Critical Care, Stamford Hospital, Stamford, CT; Clinical Professor of Medicine, Columbia University College of Physicians and Surgeons, New York, NY.
Hosp Pract (1995). 2014 Apr;42(2):14-22. doi: 10.3810/hp.2014.04.1099.
The monitoring of blood glucose and treatment of hyperglycemia has been a standard of care in intensive care units since the publication of a single-center randomized controlled trial (RCT) of intensive insulin therapy in 2001 that demonstrated marked improvements in mortality. Professional societies created guidelines based on the results of this investigation, and revised them based on the results of a very small group of RCTs that followed. This commentary reviews the weight of evidence provided by the RCTs in comparison to the large body of evidence from observational studies regarding glycemic control of the critically ill, and suggests that the totality of evidence should be considered in the formulation of clinical practice paradigms.
自2001年一项关于强化胰岛素治疗的单中心随机对照试验（RCT）发表以来，血糖监测和高血糖治疗一直是重症监护病房的护理标准，该试验证明死亡率有显著改善。专业学会根据这项调查的结果制定了指南，并根据随后一小部分RCT的结果进行了修订。本评论回顾了RCT所提供的证据权重，并与关于危重症患者血糖控制的大量观察性研究证据进行比较，建议在制定临床实践模式时应考虑全部证据。
