Perioperative Glycemic Control: An Evidence-based Review
Perioperative Glycemic Control: An Evidence-based Review
复制标题
围手术期血糖控制：循证审查
作者：
Angela Lipshutz;M. Gropper
围手术期患者的高血糖已被确定为发病率和死亡率的危险因素。强化胰岛素治疗（IIT）已被证明可以降低危重患者的发病率和死亡率，降低心脏手术后的感染率和生存率，并改善急性神经损伤和急性心肌梗死的预后。然而，最近有证据表明，与IIT相关的严重低血糖和不良事件使其安全性和有效性受到质疑。在本文中，我们总结了高血糖和IIT的机制和原理，回顾了IIT在围手术期使用的证据，并讨论了将血糖控制纳入国家质量基准的意义。我们的结论是，虽然避免高血糖显然是有益的，但适当的葡萄糖目标和可能从IIT中受益的特定亚群尚未确定。考虑到潜在的危害，将葡萄糖指标纳入国家质量基准还为时过早。
Hyperglycemia in perioperative patients has been identified as a risk factor for morbidity and mortality. Intensive insulin therapy (IIT) has been shown to reduce morbidity and mortality among the critically ill, decrease infection rates and improve survival after cardiac surgery, and improve outcomes in acute neurologic injury and acute myocardial infarction. However, recent evidence of severe hypoglycemia and adverse events associated with IIT brings its safety and efficacy into question. In this article, we summarize the mechanisms and rationale of hyperglycemia and IIT, review the evidence behind the use of IIT in the perioperative period, and discuss the implications of including glycemic control in national quality benchmarks. We conclude that while avoidance of hyperglycemia is clearly beneficial, the appropriate glucose target and specific subpopulations who might benefit from IIT have yet to be identified. Given the potential for harm, inclusion of glucose targets in national quality benchmarks is premature.
影响因子：
5.4
作者：
Goldberg, Philip A;Siegel, Mark D;Inzucchi, Silvio E
通讯作者：
Inzucchi, Silvio E