Department of Medicine, Stamford Hospital, Columbia Vagelos College of Physicians and Surgeons, Connecticut, USA.
Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Belgium.
Curr Opin Crit Care. 2019 Aug;25(4):299-306. doi: 10.1097/MCC.0000000000000621.
To summarize the advances in literature that support the best current practices regarding glucose control in the critically ill.
There are differences between patients with and without diabetes regarding the relationship of glucose metrics during acute illness to mortality. Among patients with diabetes, an assessment of preadmission glycemia, using measurement of Hemoglobin A1c (HgbA1c) informs the choice of glucose targets. For patients without diabetes and for patients with low HgbA1c levels, increasing mean glycemia during critical illness is independently associated with increasing risk of mortality. For patients with poor preadmission glucose control the appropriate blood glucose target has not yet been established. New metrics, including stress hyperglycemia ratio and glycemic gap, have been developed to describe the relationship between acute and chronic glycemia.
A 'personalized' approach to glycemic control in the critically ill, with recognition of preadmission glycemia, is supported by an emerging literature and is suitable for testing in future interventional trials.
总结有关危重病患者血糖控制的最佳当前实践的文献进展。
在急性疾病期间，血糖指标与死亡率之间的关系，在有糖尿病和无糖尿病的患者中存在差异。对于糖尿病患者，使用糖化血红蛋白（HbA1c）测量评估入院前血糖水平，可以为血糖目标的选择提供信息。对于无糖尿病的患者和 HbA1c 水平较低的患者，危重病期间平均血糖升高与死亡率增加独立相关。对于血糖控制不佳的患者，尚未确定适当的血糖目标。新的指标，包括应激性高血糖比值和血糖间隙，已经被开发出来，以描述急性和慢性血糖之间的关系。
基于对入院前血糖的认识，采用“个体化”方法来控制危重病患者的血糖，这一方法得到了新出现的文献的支持，适合在未来的干预试验中进行测试。
