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Could insulin sensitization be used as an alternative to intensive insulin therapy to improve the survival of intensive care unit patients with stress-induced hyperglycemia?

机译:可以使用胰岛素增敏替代重症胰岛素治疗,以改善重症监护病房应激性高血糖患者的生存率吗?

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摘要

The efficacy and safety of tight glucose control achieved by intensive insulin therapy (IIT) in critically ill patients have been issues of intense investigation and controversy for a decade. Hyperglycemia is associated with poor prognosis in critically ill patients. In a landmark study published in 2001, Van den Berghe and colleagues (1) demonstrated that strict glucose control by IIT halved the mortality of adult patients in the surgical intensive care unit (ICU) compared with the conventional glucose control regimen. Thereafter, many ICUs worldwide updated protocols to intensify glycemic control in critically ill patients. Subsequent large-scale, prospective, randomized, controlled clinical trials and meta-analyses, however, failed to find the benefit of IIT while showing increased risk for hypoglycemic episodes (2-5).
机译:通过重症胰岛素治疗(IIT)在重症患者中实现严格的血糖控制的有效性和安全性已经成为十年来广泛研究和争议的问题。高血糖症与重症患者的不良预后有关。在2001年发表的一项具有里程碑意义的研究中,Van den Berghe及其同事(1)证明,与常规的血糖控制方案相比,通过IIT严格控制血糖可以使外科重症监护病房(ICU)的成年患者死亡率降低一半。此后,全球许多ICU更新了方案,以加强危重患者的血糖控制。然而,随后的大规模,前瞻性,随机,对照临床试验和荟萃分析未能发现IIT的益处,同时显示出发生降血糖事件的风险增加(2-5)。

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