Hypoglycemia and strict glycemic control in critically ill patients
Hypoglycemia and strict glycemic control in critically ill patients
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危重症患者的低血糖和严格血糖控制
DOI：
10.1097/mcc.0b013e328306c7b1
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发表时间：
2008
影响因子：
3.3
通讯作者：
Joost B. L. Hoekstra
中科院分区：
文献类型：
--
作者：
T. Vriesendorp;J. Devries;Joost B. L. Hoekstra
综述的目的与糖尿病患者相比，关于危重患者低血糖后果的数据很少。本综述的目的是总结有关危重病患者低血糖的患病率、危险因素和可能的后果的现有数据。最近的发现有强有力的证据表明，严格的血糖控制对危重病人是有益的。最近试图证实这些发现的努力并未成功。相反，他们增加了对低血糖负面后果的恐惧。在接受严格血糖控制的患者中，低血糖的发生率要高出四到七倍。低血糖的危险因素是营养改变而不调整胰岛素治疗、糖尿病、败血症、休克、肝功能衰竭和需要肾脏替代治疗。危重病患者低血糖的后果尚未明确，但目前的总体证据表明，严格控制血糖的有益影响超过了低血糖可能产生的负面影响。危重患者应避免低血糖，但不能以血糖控制不严格为代价。在低血糖风险增加的患者中，可以通过有效的(计算机化的)算法和加强监测来实现严格的血糖控制和低血糖发生率。
Purpose of reviewIn contrast to patients with diabetes mellitus, data on consequences of hypoglycemia in critically ill patients are sparse. The purpose of this review is to summarize available data on prevalence of hypoglycemia, risk factors, and possible consequences of hypoglycemia in critically ill patients. Recent findingsThere is strong evidence that strict glycemic control is beneficial for critically ill patients. Recent attempts to confirm these findings have not succeeded. Instead, they have increased the fear for negative consequences of hypoglycemia. Hypoglycemia is four to seven times more frequent in patients treated with strict glycemic control. Risk factors for hypoglycemia are a change in nutrition without adjustment of insulin treatment, diabetes mellitus, sepsis, shock, liver failure, and the need for renal replacement therapy. Consequences of hypoglycemia in critically ill patients are not well defined, but overall current evidence suggests that beneficial effects of strict glycemic control outweigh possible negative effects of hypoglycemia. SummaryHypoglycemia should be avoided in critically ill patients, but not at the cost of less stringent glycemic control. Strict glycemic control with a low incidence of hypoglycemia can be achieved with a validated (computerized) algorithm and increased surveillance in patients with an increased risk for hypoglycemia.
DOI：
10.1056/nejmoa066397
发表时间：
2007-05
期刊：
The New England journal of medicine
影响因子：
--
作者：
A. Jacobson;G. Musen;C. Ryan;N. Silvers;P. Cleary;B. Waberski;Amanda Burwood;K. Weinger;M. Bayless;W. Dahms;J. Harth
通讯作者：
A. Jacobson;G. Musen;C. Ryan;N. Silvers;P. Cleary;B. Waberski;Amanda Burwood;K. Weinger;M. Bayless;W. Dahms;J. Harth
影响因子：
15.9
作者：
Suh, Sang Won;Gum, Elizabeth T.;Swanson, Raymond A.
通讯作者：
Swanson, Raymond A.
胰岛素和糖尿病。
DOI：
--
发表时间：
1986
期刊：
Transactions of the Association of American Physicians
影响因子：
--
作者：
Mako,ME;Rubenstein,AH
通讯作者：
Rubenstein,AH