doi:

DOI: 10.3724/SP.J.1264.2011.00006

Chinese Journal of Multiple Organ Diseases in the Elderly (中华老年多器官疾病杂志) 2011/10:4 PP.293-296

Progress of clinical research on stress hyperglycemia


Abstract:
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.

Key words:hyperglycemia,stress,insulin

ReleaseDate:2014-07-21 15:56:12



[1] Van den Berghe G, Wouters PJ, Bouillon R, et al. Outcome benefit of intensive insulin therapy in the critically ill: Insulin dose versus glycemic control[J]. Crit Care Med, 2003, 31(2): 359-366.

[2] Orford NR. Intensive insulin therapy in septic shock[J]. Crit Care Resusc, 2006, 8(3): 230-234.

[3] Saudek CD, Herman WH, Sacks DB, et al, A new look at screening and diagnosing diabetes mel-lilus[J]. J Clin Endocrinol Metab, 2008, 93(7): 2447-2453.

[4] Umpierrez GE, Isaacs SD, Bazargan N, et al. Hyper-glycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes[J]. J Clin Endocrinol Me-tab, 2002, 87(3): 978-982.

[5] 胡大一, 潘长玉, 余金明. 中国住院冠心病病人糖代谢异常的现况研究—— 中国心脏研究[J]. 华夏医药, 2006, 1(3): 145-149.

[6] 于健春. 危重患者高血糖的控制[J]. 中华普通外科学文献: 电子版, 2009, 3(5): 425-426.

[7] 杜彦蓉, 闵连秋. 急性脑梗死患者应激性高血糖与近期预后的关系[J]. 辽宁医学院学报, 2007, 28(4): 81-83.

[8] Adams HP Jr, del Zoppo G, Alberts MJ. Guidelines for the early management of adults with ischemic stroke[J]. Stroke, 2007, 38(5): 1655-1711.

[9] Bauters C, Ennezat PV, Tricot O, et al. Stress hyper-glycaemia is an independent predictor of left ventricular re-modelling after first anterior myocardial infarction in non-diabetic patients[J]. Eur Heart J, 2007; 28(5): 546-552.

[10] Libby P, Plutzky J. Inflammation in diabetes mellitus: role of pomxisome proliferator-activated receptor-alpha and peroxisome proliferators-activated receptor-gamma agonists[J]. Am J Cardio, 2007, 99(4): 27-40.

[11] Finfer S, Chittock DR, Su SY, et al. Intensive versus conventional glucose control in critically ill pa-tients[J]. N Engl J Med, 2009, 360(13): 1283-1297.

[12] Griesdale DE, de Souza RJ, van Dam RM, et al. Intensive insulin therapy and mortality among critically ill patients: a meta-analysis including NICE-SUGAR study data[J]. CMAJ, 2009, 180(8): 821-827.

[13] American Diabetes Association. Standards of medical care in diabetes 2008[J]. Diabetes Care, 2008, 31(1): 12-54.

[14] European Stroke Organization(ESO), Executive Committee, ESO Writing Committee. Guidelines for management of ischaemic stroke and transient ischaemic attack 2008. [J]. Cerebrovasc Dis, 2008, 25(5): 457-507.

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