Stress Hyperglycemia in Pediatric Critical Illness: The Intensive Care Unit Adds to the Stress!
Stress Hyperglycemia in Pediatric Critical Illness: The Intensive Care Unit Adds to the Stress!
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儿科危重疾病中的应激性高血糖：重症监护室增加了压力！
DOI：
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发表时间：
2012
影响因子：
5
通讯作者：
V. Srinivasan
中科院分区：
文献类型：
--
作者：
V. Srinivasan
应激性高血糖（SH）常发生在儿童危重病期间。SH有益的历史观点受到了质疑，因为有证据表明SH与更差的结局相关。除了葡萄糖代谢的内在变化和胰岛素抵抗的发展外，重症监护病房（ICU）的特殊做法可能会影响重症监护期间SH的发展。已知机械通气、血管活性物质输注、肾脏替代治疗、心肺转流和体外生命支持、治疗性低温、长时间不动、营养支持实践和药物的使用都可介导危重疾病中SH的发生。严格的血糖控制（TGC）来管理SH已成为一种有前途的治疗方法，以改善重症成人的结局，但结果尚未确定。研究中ICU实践的巨大差异可能导致不一致的结果。未来的TGC研究需要考虑常用ICU实践的影响，理想情况下，标准化方案，以提高此类研究结论的准确性。
Stress hyperglycemia (SH) commonly occurs during critical illness in children. The historical view that SH is beneficial has been questioned in light of evidence that demonstrates the association of SH with worse outcomes. In addition to intrinsic changes in glucose metabolism and development of insulin resistance, specific intensive care unit (ICU) practices may influence the development of SH during critical illness. Mechanical ventilation, vasoactive infusions, renal replacement therapies, cardiopulmonary bypass and extracorporeal life support, therapeutic hypothermia, prolonged immobility, nutrition support practices, and the use of medications are all known to mediate development of SH in critical illness. Tight glucose control (TGC) to manage SH has emerged as a promising therapy to improve outcomes in critically ill adults, but results have been inconclusive. Large variations in ICU practices across studies likely resulted in inconsistent results. Future studies of TGC need to take into account the impact of commonly used ICU practices and, ideally, standardize protocols in an attempt to improve the accuracy of conclusions from such studies.
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