Hyperglycemia and Insulin Resistance in Cardiac Arrest Patients Treated With Moderate Hypothermia
Hyperglycemia and Insulin Resistance in Cardiac Arrest Patients Treated With Moderate Hypothermia
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DOI：
10.1210/jc.2014-1449
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发表时间：
2014-10-01
影响因子：
5.8
通讯作者：
Molitch, Mark E.
中科院分区：
文献类型：
--
作者：
Ettleson, Matthew D.;Arguello, Vanessa;Molitch, Mark E.
内容：目前尚不清楚心脏骤停后和治疗性低温（TH）期间的高血糖是否是由于心脏骤停或TH，是否与不良结局相关，或者其治疗是否影响结局。目的：本研究的目的是确定TH对心脏骤停后患者血糖（BG）水平的影响以及高血糖对死亡率的影响。设计：这是2005年9月至2008年4月期间62例心脏骤停后接受TH的患者的病历审查。分析了从心脏骤停前72小时到TH后48小时的BG水平和静脉胰岛素输注率，并与出院时的生存率相关。设置：该研究在一个三级大学转诊中心进行。患者：心脏骤停后接受TH的患者参加了该研究。干预措施：TH包括尽快冷却到33摄氏度，保持该温度24小时，然后在8或16小时内控制复温到37摄氏度。hyperplasia管理与iv insulin drip protocols.Main Outcome Measure：心脏骤停和低体温与高血糖的关系，一个关键的次要结果是高血糖与生存出院的关系，是measured.Results：葡萄糖模式分析显示TH对BG水平没有独立的影响。在心脏骤停和开始低温治疗之间，死亡者的平均血糖水平（253 +/- 112 mg/dL，n = 48）高于存活者（192 +/- 69 mg/dL，n = 24，P = 0.016）。BG，胰岛素输注率，胰岛素抵抗在低温，复温期间，和24-48小时后，低温2 groups.Conclusions：在TH治疗的患者中，TH没有独立的影响BG水平。死亡率与心脏骤停后但在开始TH或胰岛素滴注前血糖水平升高相关。很可能，心脏骤停引起的压力的严重性导致了这些患者的高血糖症。
Context: It is unknown whether the hyperglycemia that follows cardiac arrest and during therapeutic hypothermia (TH) is due to the arrest or the TH, whether it is associated with adverse outcomes, or whether its treatment affects outcomes.Objective: The objective of the study was to determine the effects of TH on the blood glucose (BG) levels in postcardiac arrest patients and the effects of hyperglycemia on mortality.Design: This was a chart review of 62 patients undergoing TH after cardiac arrest between September 2005 and April 2008. BG levels from 72 hours before the arrest to 48 hours after TH and iv insulin infusion rates were analyzed and correlated with survival to discharge from hospital.Setting: The study was conducted at a tertiary, university referral center.Patients: Patients undergoing TH after cardiac arrest participated in the study.Interventions: TH consisted of cooling as rapidly as possible to 33 degrees C, holding that temperature for 24 hours, and then controlled rewarming to 37 degrees C over 8 or 16 hours. Hyperglycemia was managed with iv insulin drip protocols.Main Outcome Measure: The relationship of cardiac arrest and hypothermia to hyperglycemia, with a key secondary outcome being the relationship of hyperglycemia to survival to discharge, was measured.Results: Analysis of glucose patterns showed no independent effect of TH on BG levels. Mean BG levels between cardiac arrest and the initiation of hypothermia were higher in nonsurvivors (253 +/- 112 mg/dL, n = 48) than in survivors (192 +/- 69 mg/dL, n = 24, P = .016). BG, insulin infusion rates, and insulin resistance during hypothermia, during rewarming, and 24-48 hours after hypothermia were not significantly different between the 2 groups.Conclusions: In patients treated with TH, the TH had no independent effect on BG levels. Mortality was associated with increased BG levels after cardiac arrest but before initiation of TH or an insulin drip. Likely, it is the severity of stress from the cardiac arrest that causes the hyperglycemia in these patients.