Influence of Glycemic Control on Endogenous Circulating Ketone Concentrations in Adults Following Traumatic Brain Injury.
Influence of Glycemic Control on Endogenous Circulating Ketone Concentrations in Adults Following Traumatic Brain Injury.
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DOI：
10.1007/s12028-016-0313-3
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发表时间：
2017-04
影响因子：
3.5
通讯作者：
Glenn TC
中科院分区：
文献类型：
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作者：
Wolahan SM;Prins ML;McArthur DL;Real CR;Hovda DA;Martin NA;Vespa PM;Glenn TC
目的是研究严格血糖控制（4.4-6.1 mM）对严重颅脑损伤成人内源性生酮的影响。数据是在一项随机的、患者内交叉研究中收集的，该研究比较严格和宽松的血糖控制，定义为6.7-8.3 mM。在严格和宽松的血糖控制时期定期采集血液。对胰岛素剂量和总营养供给进行事后分析。15名患者完成了交叉研究。与血糖控制宽松（6.7-8.3 mM）相比，血糖控制严格（4.4-6.1 mM）时，总酮增加了81µM ([38 135], p<0.001)，相当于增加了60%。总营养供给显著减少（p=0.006），胰岛素剂量显著增加（p=0.008）。当目标是严格控制血糖时，允许进食不足是可以容忍的，但在治疗高血糖时，全面营养支持是重要因素。
The objective was to investigate the impact of targeting tight glycemic control (4.4–6.1 mM) on endogenous ketogenesis in severely head injured adults. The data were prospectively collected during a randomized, within-patient crossover study comparing tight to loose glycemic control, defined as 6.7–8.3 mM. Blood was collected periodically during both tight and loose glycemic control epochs. Post hoc analysis of insulin dose and total nutritional provision was performed. Fifteen patients completed the crossover study. Total ketones were increased 81 µM ([38 135], p<0.001) when blood glucose was targeted to tight (4.4–6.1 mM) compared with loose glycemic control (6.7–8.3 mM), corresponding to a 60% increase. There was a significant decrease in total nutritional provisions (p=0.006) and a significant increase in insulin dose (p=0.008). Permissive underfeeding was tolerated when targeting tight glycemic control but total nutritional support is an important factor when treating hyperglycemia.