住院病人的血糖管理 医学PPT课件.pptVIP

due to the progressive nature and low percentage of the diagnosed and treamtment * * 而且，高血糖在住院患者中普遍存在，住院患者中糖尿病的患病率约为12%-25%；此外，在应激状态下，糖尿病患者出现更明显的高血糖；无糖尿病的患者也可出现暂时性的高血糖。 * Updated: * * Hyperglycemia in Patients With Undiagnosed Diabetes New hyperglycemia was defined as an admission or in-hospital fasting glucose level of 126 mg/dL (7 mmol/L) or more or a random blood glucose level of 200 mg/dL (11.1 mmol/L) or more on 2 or more determinations. Hyperglycemia was present in 38% of patients admitted to the hospital, of whom 26% had a known history of diabetes, and 12% had no history of diabetes before admission. Newly discovered hyperglycemia was associated with a higher in-hospital mortality rate (16%) compared with patients with a history of diabetes (3%) and patients with normoglycemia (1.7%; both P 0.01). In addition, new hyperglycemic patients had longer hospital stays and a higher admission rate to an intensive care unit, and were less likely to be discharged to home, frequently requiring transfer to a transitional care unit or nursing home facility. The results indicate that in-hospital hyperglycemia is a common finding and represents an important marker of poor clinical outcome and mortality in patients with and without a history of diabetes. Patients with newly diagnosed hyperglycemia had a significantly higher mortality rate and a lower functional outcome than patients with a known history of diabetes or normoglycemia. 1. Umpierrez GE, Isaacs SD, Bazargan N, et al. Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes. J Clin Endocrinol Metab. 2002;87:978-982. * 严格控制住院患者的血糖可以： 降低死亡率 降低并发症和感染率 缩短患者住院时间 降低患者的医疗费用 * 下表中列出了ADA和AACE对院内血糖控制目标建议： ADA推荐ICU患者的血糖控制应尽可能接近6.5mmol/L，一般 10.0mmol/L ；普通科室患者的血糖控制应尽可能接近 5.0—7.2mmol/L ，最高 10.0mmol/L AACE推荐ICU患者的血糖控制应6.5mmol/L，普通科室患者的血糖控制应为餐前6.5mmol/L， 最高10.0mmol/L * Updated: * * Methods for Managing Hospitalized Persons With Diabetes Insulin, whether given intravenously or