Perioperative diabetic and hyperglycemic management issues
Perioperative diabetic and hyperglycemic management issues
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DOI：
10.1097/01.ccm.0000115623.52021.c0
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发表时间：
2004-04-01
影响因子：
8.8
通讯作者：
Ketzler, JT
中科院分区：
文献类型：
--
作者：
Coursin, DB;Connery, LE;Ketzler, JT
目的和设计：回顾和讨论选定的文献、专家意见以及高血糖围手术期或危重症患者的常规护理。要点。糖尿病是围手术期最常见的内分泌疾病，其患病率持续急剧增加。糖尿病是美国第六大常见死因，并显着影响其他更常见的死因，例如心脏病和中风。糖尿病患者通常患有微血管和大血管病理，这会影响他们的围手术期和危重疾病，并增加住院期间的发病率和死亡率。由于糖尿病患者比非糖尿病患者需要更多的手术并更频繁地接受重症监护，因此对糖尿病并发症和合并症的预先识别和预测以及优化的治疗计划是对这一不断增长的患者群体进行适当重症监护的基础。高血糖常见于危重糖尿病患者，但也常见于有正常血糖稳态病史的患者。危重患者新发的高血糖是由过度的反调节应激激素释放以及组织和循环中炎性细胞因子的高浓度驱动的。积极的血糖管理可改善患有急性心肌梗死的糖尿病患者和心脏手术患者的短期和长期预后。最近，糖尿病和非糖尿病高血糖重症监护病房患者的“严格”血糖控制提高了选定手术患者的生存率，而没有与低血糖相关的过度后果。血糖正常的益处机制似乎是多因素的。结论。入住重症监护病房的患者中，高达 25% 之前曾诊断出糖尿病。糖尿病患者最常入院治疗共病并发症。新发高血糖在危重患者中也很常见，它会影响患者的发病率和死亡率。越来越多的文献支持严格血糖控制对某些患者群体的益处。然而，关于最佳血糖浓度、在更广泛的患者群体（包括重症患者）中维持血糖正常的作用以及输注葡萄糖和胰岛素的益处机制，还需要进一步的数据。
Objective and Design: To review and discuss selected literature, expert opinion, and conventional care of the hyperglycemic perioperative or critically ill patient.Main Points. Diabetes mellitus, the most commonly encountered perioperative endocrinopathy, continues to increase dramatically in prevalence. Diabetes is the sixth most common cause of death in the United States and significantly affects other more common causes of death such as cardiac disease and stroke. Diabetic patients commonly have microvascular and macrovascular pathology that influences their perioperative course and critical illness and increases morbidity and mortality rates during hospitalization. Since diabetics require more surgeries and receive critical care more frequently than their nondiabetic counterparts, preemptive identification and anticipation of diabetic complications and comorbidities, along with an optimized treatment plan, are the foundation for the proper intensive care of this growing patient population. Hyperglycemia occurs commonly in critically ill diabetic patients but also is frequent in those who have a history of normal glucose homeostasis. The new onset of hyperglycemia in critically ill patients is driven by excessive counterregulatory stress hormone release and high tissue and circulating concentrations of inflammatory cytokines. Aggressive glycemic management improves short- and long-term outcomes in diabetic patients with acute myocardial infarction and cardiac surgical patients. Most recently, "tight" glycemic control in both diabetic and nondiabetic hyperglycemic intensive care unit patients resulted in improved survival in selected surgical patients without excessive consequences related to hypoglycemia. The mechanisms of benefit of euglycemia appear to be multifactorial.Conclusions. Up to 25% of patients admitted to the intensive care unit have previously diagnosed diabetes. Diabetics are most commonly admitted for treatment of complications of comorbid diseases. New-onset hyperglycemia also is common in critically ill patients, and it affects patient morbidity and mortality rates. A growing body of literature supports the benefits of tight glycemic control in certain patient populations. However, further data are needed about the optimal concentration of blood glucose, the role of maintaining euglycemia in a broader group of patients (including the medically critically ill), and the mechanisms of benefit of infused glucose and insulin.