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首页> 外文期刊>Current opinion in gastroenterology >Near-normal glycemia for critically ill patients receiving nutrition support: fact or folly.
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Near-normal glycemia for critically ill patients receiving nutrition support: fact or folly.

机译：重症患者接受营养支持的血糖接近正常：事实或愚蠢。

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PURPOSE OF REVIEW: In critically ill patients, nutrition support may be a life-saving intervention, but is not without risk. Adverse metabolic changes, including hypertriglyceridemia and hyperglycemia, are common. Hyperglycemia is associated with adverse outcomes, in particular, infection. Four major studies have addressed whether near-normal glycemia (80-110 mg/dl) in this clinical setting improves outcomes compared with blood sugars of approximately 150 mg/dl. The purpose of this review is to determine whether tight glycemic control is superior to moderate glycemic control (150 mg/dl) in critically ill patients receiving nutrition support. RECENT FINDINGS: Initial data collected in postsurgical patients suggested that near-normal glycemia dramatically improved outcomes compared with moderate glycemic control. However, three recent studies were unable to duplicate these results and suggest that the benefits of tight glycemic control may be limited to postsurgical patients. Controlling hyperlipidemia and preventing overfeeding may improve outcomes more than tight control of blood sugars. Furthermore, near-normal glycemic control caused frequent hypoglycemia and, in some cases, worsened outcomes. SUMMARY: Glycemic control to approximately 150 mg/dl is not inferior to near-normal glycemia in critically ill patients requiring nutrition support and is clearly safer. Lipid changes caused by insulin infusion may improve outcomes more than glycemic control itself, and prevention of hypertriglyceridemia should be a major focus of clinical care.
机译：审查目的：在重症患者中，营养支持可能是挽救生命的干预措施，但并非没有风险。不良的代谢变化，包括高甘油三酯血症和高血糖症，很常见。高血糖症与不良后果（尤其是感染）相关。四项主要研究已经探讨了与大约150 mg / dl的血糖相比，在这种临床情况下接近正常的血糖水平（80-110 mg / dl）是否可以改善预后。这篇综述的目的是确定在接受营养支持的危重患者中，严格的血糖控制是否优于中等血糖控制（150 mg / dl）。最新发现：术后患者收集的初步数据表明，与中度血糖控制相比，近乎正常的血糖可显着改善结局。然而，最近的三项研究无法重复这些结果，并表明严格控制血糖的益处可能仅限于术后患者。与严格控制血糖相比，控制高脂血症和防止过度喂养可能会改善预后。此外，近乎正常的血糖控制导致频繁的低血糖症，并且在某些情况下，恶化了预后。简介：在需要营养支持的危重患者中，血糖控制在150 mg / dl左右并不逊色于接近正常的血糖水平，而且显然更安全。胰岛素输注引起的脂质变化可能比血糖控制本身更能改善预后，而预防高甘油三酯血症应成为临床护理的主要重点。

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