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脓毒症患者的强化胰岛素治疗:更好的数据有助于更好的干预。

Intensive insulin therapy in sepsis patients: Better data enables better intervention.

作者信息

Wang Ling, Wang Min, Du Jie, Gong Zhi-Cheng

机构信息

Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China.

Hunan Clinical Research Center for Clinical Pharmacy, Xiangya Hospital, Central South University, Changsha, China.

出版信息

Heliyon. 2023 Feb 24;9(3):e14063. doi: 10.1016/j.heliyon.2023.e14063. eCollection 2023 Mar.

Abstract

In clinics, sepsis is a critical disease that often develops into shock and multiple organ dysfunction, leading to a serious threat of death. Patients with sepsis are often accompanied by stress hyperglycemia which is an independent risk factor for poor prognosis in sepsis. Thus, the treatment for stress hyperglycemia has attracted more and more attention, among which intensive insulin therapy is widely concerned. However, the benefits and harms of intensive insulin therapy for sepsis patients remain controversial. What the existing literature discusses mostly are the clinical benefit and hypoglycemia risk of intensive insulin therapy, but there is no conclusion on the target range of blood glucose control, the applicable patients, the timing of treatment initiation, and how to avoid the risk. In this study, we have analyzed and summarized the existing literature, hoping to determine the adverse and clinical benefit of intensive insulin therapy in sepsis. And we attempt to assemble better evidence to propose a better recommendation on hyperglycemia intervention for sepsis patients.

摘要

在临床上,脓毒症是一种危急疾病,常发展为休克和多器官功能障碍,对生命构成严重威胁。脓毒症患者常伴有应激性高血糖,这是脓毒症预后不良的独立危险因素。因此,应激性高血糖的治疗越来越受到关注,其中强化胰岛素治疗备受关注。然而,强化胰岛素治疗对脓毒症患者的利弊仍存在争议。现有文献大多讨论的是强化胰岛素治疗的临床益处和低血糖风险,但在血糖控制目标范围、适用患者、治疗起始时机以及如何规避风险等方面尚无定论。在本研究中,我们分析总结了现有文献,旨在确定强化胰岛素治疗在脓毒症中的不良影响和临床益处。并且我们试图收集更充分的证据,为脓毒症患者高血糖干预提出更好的建议。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3269/10006498/ba41f44fe1d0/ga1.jpg

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