Tsai Lillian L, Jensen Hanna A, Thourani Vinod H
Division of Cardiothoracic Surgery, Joseph B. Whitehead Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA.
Curr Diab Rep. 2016 Apr;16(4):25. doi: 10.1007/s11892-016-0719-5.
Hyperglycemia has been found to be associated with increased morbidity and mortality in surgical patients, yet, the optimal glucose management strategy during the perioperative setting remains undetermined. While much has been published about hyperglycemia and cardiac surgery, most studies have used widely varying definitions of hyperglycemia, methods of insulin administration, and the timing of therapy. This has only allowed investigators to make general conclusions in this challenging clinical scenario. This review will introduce the basic pathophysiology of hyperglycemia in the cardiac surgery setting, describe the main clinical consequences of operative hyperglycemia, and take the reader through the published material of intensive and conservative glucose management. Overall, it seems that intensive control has modest benefits with adverse effects often outweighing these advantages. However, some studies have indicated differing results for certain patient subgroups, such as non-diabetics with acute operative hyperglycemia. Future studies should focus on distinguishing which patient populations, if any, would optimally benefit from intensive insulin therapy.
高血糖已被发现与外科手术患者的发病率和死亡率增加有关，然而，围手术期的最佳血糖管理策略仍未确定。虽然关于高血糖与心脏手术的研究已发表了很多，但大多数研究对高血糖的定义、胰岛素给药方法和治疗时机差异很大。这使得研究人员只能在这种具有挑战性的临床情况下得出一般性结论。本综述将介绍心脏手术中高血糖的基本病理生理学，描述手术期高血糖的主要临床后果，并带领读者了解有关强化和保守血糖管理的已发表资料。总体而言，强化控制似乎有适度益处，但不良反应往往超过这些优势。然而，一些研究表明某些患者亚组（如急性手术期高血糖的非糖尿病患者）有不同的结果。未来的研究应专注于区分哪些患者群体（如果有的话）将从强化胰岛素治疗中获得最大益处。
