Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik, 808, 1070, Brussels, Belgium.
Curr Diab Rep. 2019 Nov 20;19(11):133. doi: 10.1007/s11892-019-1274-7.
To provide an update of glycemic management during metabolic stress related to surgery or critical illness.
There is a clear association between severe hyperglycemia, hypoglycemia, and high glycemic variability and poor outcomes of postoperative or critically ill patients. However, the impressive beneficial effects of tight glycemic management (TGM) by intensive insulin therapy reported in one study were never reproduced. Hence, the recommendation of TGM is now replaced by more liberal blood glucose (BG) targets (< 180 mg/dL or 10 mM). Recent data support the concept of targeting individualized blood glucose (BG) values according to the presence of diabetes mellitus/chronic hyperglycemia, the presence of brain injury, and the time from injury. A more liberal glycemic management goal is currently advised during metabolic stress and could be switched to individualized glycemic management once validated by prospective trials.
提供代谢应激期间血糖管理的最新信息，包括手术或危重病相关的血糖管理。
严重高血糖、低血糖和高血糖变异性与术后或重症患者的不良结局密切相关。然而，强化胰岛素治疗的严格血糖管理（TGM）所带来的显著有益效果在一项研究中从未重现。因此，TGM 的推荐已被更宽松的血糖（BG）目标（<180mg/dL 或 10mM）所取代。最近的数据支持根据糖尿病/慢性高血糖的存在、脑损伤的存在以及损伤后的时间来确定个体化 BG 值的目标。目前建议在代谢应激期间采用更宽松的血糖管理目标，一旦前瞻性试验验证后，可切换至个体化血糖管理。
