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首页> 外文期刊>International Journal of General Medicine >Does tight glycemic control improve outcomes in pediatric patients undergoing surgery and/or those with critical illness?
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Does tight glycemic control improve outcomes in pediatric patients undergoing surgery and/or those with critical illness?

机译：严格的血糖控制是否可以改善接受手术和/或患有严重疾病的小儿患者的预后？

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Abstract: This literature review examines the current evidence regarding the potential usefulness of tight glycemic control in pediatric surgical patients. In adults, fluctuations in glucose levels and/or prolonged hyperglycemia have been shown to be associated with poor outcomes with respect to morbidity and mortality. This review begins by summarizing the findings of key papers in adult patients and continues by investigating whether or not similar results have been seen in pediatric patients by performing a comprehensive literature review using Medline (OVID). A database search using the OVID interface and including the search terms (exp glucose) AND (exp surgery) AND (exp Paediatric/pediatric) AND (exp Hypoglycaemia/hypoglycemia) AND (exp Hyperglycaemia/hyperglycemia) yielded a total of 150+ papers, of which 24 fulfilled our criteria. We isolated papers utilizing pediatric patients who were hospitalized due to illness and/or surgery. Our review highlights several difficulties encountered in addressing this potentially useful clinical intervention. An absence of scientifically robust and randomized trials and the existence of several small-powered trials yielding conflicting results mean we cannot recommend tight glycemic control in these patients. Differences in study design and disagreements concerning the crucial stage of surgery where hyperglycemia becomes important are compounded by an over-reliance on the discretion of clinicians in the absence of well described treatment protocols. Closer inspection of key papers in adult patients identified fundamental discrepancies between exact definitions of both hyperglycemia and hypoglycemia. This lack of consensus, along with a fear of inducing iatrogenic hypoglycemia in pediatric patients, has resulted in professional bodies advising against this form of intervention. In conclusion, we cannot recommend use of tight glycemic control in pediatric surgical patients due to unclear glucose definitions, unclear thresholds for treatment, and the unknown long-term effects of iatrogenic hypoglycemia on the developing body and brain.
机译：摘要：这篇文献综述检查了有关严格控制血糖在儿科手术患者中潜在用途的最新证据。在成年人中，血糖水平的波动和/或长时间的高血糖症已被证明与发病率和死亡率方面的不良预后有关。这篇综述首先总结了成年患者关键论文的发现，然后通过使用Medline（OVID）进行全面的文献综述，调查在小儿患者中是否观察到了相似的结果。使用OVID界面进行的数据库搜索，包括搜索词（exp葡萄糖）AND（exp外科手术）AND（exp儿科/儿科）AND（exp低血糖/低血糖）AND（exp高血糖/高血糖），总共产生了150多篇论文，其中24个符合我们的标准。我们利用因疾病和/或手术而住院的小儿患者的文献进行隔离。我们的综述强调了在解决这种潜在有用的临床干预措施时遇到的一些困难。缺乏科学的，随机的科学试验，以及一些产生矛盾结果的小功率试验，意味着我们不建议对这些患者进行严格的血糖控制。在缺乏重要治疗方案的情况下，过度依赖临床医生的判断力加剧了研究设计的差异以及关于高血糖变得重要的手术关键阶段的分歧。对成年患者关键论文的仔细检查发现，高血糖症和低血糖症的确切定义之间存在根本差异。缺乏共识，加上担心在儿科患者中诱发医源性低血糖症，导致专业机构建议不要采取这种干预措施。总之，由于血糖定义不清楚，治疗阈值不清楚以及医源性低血糖对发育中的身体和大脑的长期影响未知，我们不建议在儿科手术患者中使用严格的血糖控制。

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