危重病高血糖与强化胰岛素治疗现状

高血糖在危重病患者中非常普遍。血糖持续高水平与危重病病情呈正相关。危重患者出现高血糖主要由激素应激性胰岛素抵抗效应及炎性细胞因子的作用所致。高血糖对机体各组织器官影响是多方面的,是危重患者病情严重程度的显著标志。强化胰岛素治疗控制血糖水平在4.4～6.1 mmoL/L可以降低危重患者的并发症发生率及死亡率,改善预后,降低医疗费用。最佳的血糖调控方案既要能很好地控制血糖,又不造成低血糖发生。高血糖指数作为评估血糖控制指标比较合理,但是强化胰岛素治疗方案的具体实施有很多实际困难。

Relationship between hyperglycemia and intensive insulin therapy in critically ill patients

Hyperglycemia is common in critically ill patients.Continuous high level of blood glu- cose has a positive correlation with the conditions of critically ill patients.The presence of the hyperglyce- mia in critically illness patients is mainly induced by the effects of hormone stress on insulin resistance and the inflammatory cytokine action.Hyperglycemia,which is an important sign showing the conditions of a critically ill patient,has various effects on body tissues.Tight control of blood glucose at a level between 4.4 mmol/L and 6.1 mmol/L by intensive insulin therapy are able to decrease the complication incidence and mortality of critical illness,improve prognosis,and reduce the expenses for medical care.The best regulation of blood glucose can not only control the blood glucose at proper level but also avoid the occur- rence of hypoglycemic.It is more resonable to evaluate the control indexes of blood glucose by hyperglyce- mia index than others,but the implementation of intensive insulin therapy has to face many practical diffi- culties.