ICU血糖管理 45页.pptVIP

During the 90-day study period, there was no significant difference between the two groups in the median length of stay in the ICU 在90天的研究期间，2组ICU平均留住时间没有显著差异 The number of patients in whom new single or multiple organ failures developed were similar with intensive and conventional glucose control (P = 0.11) 新发生的单个或多器官功能衰竭，2组相似 There was no significant difference between the two groups in the numbers of days of mechanical ventilation and renal replacement therapy 机械通气时间和肾脏替代疗法没有显著差异 In this large, international, randomized trial, we found that intensive glucose control increased mortality among adults in the ICU: a blood glucose target of 180 mg(10.0 mmol or less per liter) or less per deciliter resulted in lower mortality than did a target of 81 to 108 mg per deciliter(4.5 to 6.0 mmol per liter). 这次大样本国际随机实验显示：在ICU患者强化胰岛素治疗增加死亡率，与4.5-6mmol/dl的目标血糖水平相比 ，10mmol/dl及以下的血糖水平能降低死亡率 On the basis of our results, we do not recommend use of the lower target in critically ill adults. 推建目标血糖水平为10mmol/dl及以下 the second largest randomized study sample (to our knowledge) in the history of critical care medicine, it would clearly provide level I evidence to guide clinicians in their decision making at the bedside NICE SUGAR研究为临床医生的工作提供了一级证据 This detrimental intensive insulin therapy (IIT) mortality effect in the NICE-SUGAR trial occurred in all subgroups, including surgical patients. As such, when considering a diverse population of ICU patients, the IIT express has surely come to its last stop（强化血糖可以休矣！）. Do not treat hyperglycemia unless the glucose level increases higher than 180 mg/dL; when you do treat hyperglycemia, aim for a target blood glucose concentration between 144 and 180 mg/dL. Until a study can provide level I evidence that a better approach exists, this should remain the standard of care 重症患者血糖不高于10 mmol/L可不处理，如果一定要控制血糖，目标血糖应该是8-10 mmol/L，除非之后出现更好的1级证据，否则NICE-SUGAR研究就是标准方案 What Is a NICE-SUGAR for Patients in the Intensive Care Uni