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題名 | 重症病患的血糖控制=Blood Sugar Control in Critically Ill patients |
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作 者 | 黃煜為; 尹彙文; | 書刊名 | 中華民國重症醫學雜誌 |
卷期 | 6:3 民93 |
頁次 | 頁234-241 |
分類號 | 415.668 |
關鍵詞 | 重症; 高血糖; 胰島素; 糖尿病; Critically ill; Hyperglycemia; Insulin; Diabetes mellius; |
語文 | 中文(Chinese) |
中文摘要 | 重症病患不論是否有糖尿病史,常患有高血糖,而重症高血糖是因為人體面對重症時,所產生的一些生理及病理的變化所導致,在過去面對重症引起的高血糖,並沒有很積極的給予治療及控制,直到最近,新的研究證據帶來了新的觀念。在"Intensive insulin therapy in critically ill patients"研究中,總共1548位重症病患,隨機分成兩組,傳統治療組的病患血糖值在高於220mg/dL時才給予治療,嚴格治療組的病患則是接受胰島素連續注射以控制血糖值在80-110mg/dL,結果顯示,嚴格治療組的病患死亡率較低,發生併發症,例如:腎衰竭,神經病變及感染,比率較少,對呼吸器使用的需求也下降了。這樣的結果顯示了嚴格控制重症病患血糖值的益處,但對於其詳細的作用機轉,在不同的病患族群是否具有一樣的效果,還有什麼樣的血糖值對重症病患才是最理想的血糖值,這些問題都需要更進一步的研究來找出答案。 |
英文摘要 | Critically ill patients often have hyperglycemia, whether or not they have history of diabetes mellitus. Critically ill hyperglycemia is considered to be part of the physiological and pathological responses to critical illness. In the past, the physicians and intensivists took less aggressive approach to critically ill hyperglycemia control and treatment. Until now, the new evidence of recent studies has brought novel insights. In "Intensive insulin therapy in critically ill patients" study, 1548 critically ill patients had been randomly allocated to the conventional group and intensive insulin therapy group. In the conventional group, insulin infusion started only when blood sugar excess 220 mg/dL and in the intensive insulin therapy group, insulin infused to keep blood sugar between 80-110mg/dL. The results showed that intensive insulin therapy had less mortality and morbidity, such as acute renal failure, neuropathy, infection and ventilator-dependency. The results showed the beneficial effects of intensive insulin therapy, but the mechanisms were still unclear. Are the beneficial effects the same for different patient populations? What is the ideal blood sugar level? We need further investigations for the answers of these questions. |
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