应激性高血糖的临床研究进展

Progress of clinical research on stress hyperglycemia

应激性高血糖在危重症患者中普遍存在并严重影响其预后。应激性高血糖正逐渐受到广泛重视和研究,其发生机制目前已经基本阐明。应激性高血糖的治疗主要是胰岛素治疗,研究表明胰岛素治疗可降低危重症患者的病死率并改善其预后。但由于胰岛素治疗在危重症患者中应用时间较短,胰岛素治疗的血糖控制目标仍然存在一定争议,目前临床上还没有统一的血糖控制目标。本文在简述应激性高血糖的流行病学特征的基础上,探讨了应激性高血糖的发生机制及其重要临床意义。回顾了胰岛素治疗的研究进展并分析了强化胰岛素治疗的优缺点,最后提出了胰岛素治疗的原则和对于不同患者的血糖控制目标。

Stress hyperglycemia is very common among critically ill patients, and seriously affects its prognosis. Currently, it attracts increasing attention. Its mechanism has been elucidated. The treatment of stress hyperglycemia mainly depends on insulin therapy. It is reported that insulin therapy can reduce the mortality of critically ill patients and improve their prognosis. However, because insulin therapy has been applied for a relatively short duration in critically ill patients, the target glycemic control level is still controversial. At present, there is no unified standard yet for glycemic control level in the clinical practice. In this paper, we introduced briefly the epidemiological characteristics of stress hyperglycemia. Additionally, we also discussed its mechanism and clinical significance. We reviewed the progress of research on insulin therapy and analyzed the good and bad points of intensive insulin therapy. We also proposed the principles of insulin therapy and target level of glycemic control for different patients.