危重病高血糖与强化胰岛素治疗  

Critically Ill with Hyperglycemia and Intensive Insulin Therapy

作　　者：吴迪[1] 

机构地区：[1]天津市环湖医院ICU,天津300060

出　　处：《医学综述》2008年第9期1356-1358,共3页Medical Recapitulate

摘　　要：应急性高代谢通常继发于较大的创伤或急性疾病,其与高血糖或胰岛素抵抗有关,通常是指应急糖尿病或损伤性糖尿病。在危重患者,甚至这些人还没有被诊断为糖尿病,葡萄糖摄取和外周胰岛素敏感性下降导致高血糖症。有一观点是普遍接受的——在危重患者中适当的高血糖是有益的,作为一些不需要胰岛素对于葡萄糖摄取的能源供给的这些器官有脑、免疫系统。然而,逐渐增多的证据表明,可接受的高血糖程度与危重患者在高血糖期间产生有害的结果相关。此外,在内、外科ICU大组随机对照实验调查提示,强化胰岛素治疗能明显改善发病率和病死率。血糖的控制和与葡萄糖无关的胰岛素的作用似乎对治疗有益的方面起了作用。The hypermetabolic stress response that usually follows any type of major trauma or acute illness is associated with hyperglycemia and insulin resistance, often referred to stress diabetes or diabetes of injury. In critically ill patients, even in those who were not previously diagnosed with diabetes, glucose uptake is reduced in peripheral insulin sensitive tissues, whereas endogenous glucose production is increased, resulting in hyperglycemia. It has long been generally accepted that a moderate hyperglycemia in critically ill patients is beneficial to ensure the supply of glucose as a source of energy to organs that do not require insulin for glucose uptake, among which are the brain and the immune system. An increasing body of evidence, however, associates the upon-admission degree of hyperglycemia and the duration of hyperglycemia during critical illness with adverse outcome. Moreover, a recent randomized, controlled trial in a large group of surgical intensive care patients demonstrated that tight blood glucose control with insulin therapy significantly improves morbidity and mortality. Blood glucose control and glucose-independent actions of insulin seem to contribute to the beneficial effects of the therapy.

关 键 词：高血糖 危重病 强化胰岛素治疗 

分 类 号：R59[医药卫生—内科学]