【正文】 THANK YOU,第六十二頁(yè)，共六十二頁(yè)。)) 分泌異常。ir243。o),輕者口服糖水或糖果(t225。t225。nzh242。tǒng)癥狀,腦細(xì)胞所需能量幾乎完全來自葡萄糖 肝糖原耗竭(h224。ozhěng)方案,第五十六頁(yè)，共六十二頁(yè)。t225。zh236。ji224。,胰島素輸入方案： 血糖(xu232。,Protocol 控制(k242。ng)波動(dòng)較小 而患者恢復(fù)進(jìn)食后要加用三餐胰島素,可以按0. 4～1. 0 U/ kg 給予胰島素總量 40 %～50 %作為胰島素基礎(chǔ)量。)三餐飲食的患者,危重期患者不進(jìn)食血糖(xu232。h233。ng)控制,要求在12～24h內(nèi)使血糖達(dá)到控制目標(biāo) 血糖測(cè)定連續(xù)3次以上達(dá)控制目標(biāo),測(cè)定頻率可改為4h一次 起始劑量4～6U/ h 血糖以每小時(shí)4～6mmol/ L 速度下降 如果2 h 血糖不能滿意下降, 提示患者(hu224。ngqu232。)和血糖控制,常規(guī)測(cè)紙片法 化驗(yàn)室用血清法 監(jiān)測(cè)血糖值 初期頻繁監(jiān)測(cè)血糖(每30~60min) 血糖穩(wěn)定后定期監(jiān)測(cè)(每4h) 控制血糖的方法(fāngfǎ)： 持續(xù)輸注胰島素和葡萄糖,第四十五頁(yè)，共六十二頁(yè)。,小結(jié)(xiǎoji233。,sweet spot,作者認(rèn)為可能存在一個(gè)“sweet spot位點(diǎn)”，既能夠避免低血糖的危害又能夠嚴(yán)重(y225。i shi)小鐘擺?,2 June 2009 | Volume 150 Issue 11 | Pages 809811,第四十頁(yè)，共六十二頁(yè)。 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 重癥患者血糖不高于180 mg/dl可不處理，如果一定要控制血糖，目標(biāo)血糖應(yīng)該是144180 mg/dl，除非之后出現(xiàn)(chūxi224。ng)又是如何增加病死率的，今后我們?nèi)绾沃委烮CU內(nèi)的高血糖(xu232。n chu225。o zhǔn)可下降42%，這是任何治療都無法達(dá)到的，低血糖的風(fēng)險(xiǎn)等 At that time, we chose not to highlight even more sources of concern, such as the intrinsic limitations of singlecenter studies, which make them unsuitable for level I evidence 單中心的研究提供不了一級(jí)證據(jù),What Is a NICESUGAR for Patients in the Intensive Care Unit?,相關(guān)(xiāngguān)述評(píng) （二） A NUMBER OF SERIOUS LIMITATIONS,第三十六頁(yè)，共六十二頁(yè)。n chu225。)內(nèi)分泌協(xié)會(huì),Finally, the rush to deploy difficult and resourceintensive protocols in ICU’s may be premature until there is a better understanding of the reasons that the NICESUGAR results differ so markedly from those of an earlier study by Van den Berghe et al. 在明確原因之前，貿(mào)然推動(dòng)復(fù)雜且消耗資源的規(guī)章指南還為時(shí)尚早 We believe physicians should individually tailor their approach to glycemic control in their ICU patients, perhaps targeting glucose values between 144180 mg/dl, until we better understand the reasons for these somewhat counterintuitive findings 在未闡明各項(xiàng)強(qiáng)化血糖控制研究結(jié)論(ji233。nghu224。,subgroup analyses,With respect to 90day mortality, subgroup analyses suggested no significant difference 90天死亡率亞組間沒有顯著(xiǎnzh249。,器官功能衰竭，機(jī)械(jīxi232。,ICU留住(li 95% confidence interval, 1.01 to 1.23。n)時(shí)間,Ninety days after randomization, 829 of 3010 patients (27.5%) in the intensivecontrol group had died, as compared with 751 of 3012 patients (24.9%) in the conventionalcontrol group 隨機(jī)分組后90天， 強(qiáng)化(qi225。ng)衰竭患者比例；機(jī)械通氣時(shí)間，腎臟替代時(shí)間，血培養(yǎng)陽(yáng)性率和輸血比例等諸多方面也沒有顯示出和常規(guī)治療組之間的差異。應(yīng)用胰島素。,方法(fāngfǎ),Control of blood glucose was achieved with the use of an intravenous infusion of insulin in saline. 靜脈注射胰島素控制血糖 In the group of patients assigned to undergo conventional glucose control, insulin was administered if the blood glucose level exceeded 180 mg per deciliter (10.0 mmol per liter)。,NICE SUGAR研究(y225。,NICE SUGAR研究(y225。,Can controlling blood sugar levels in the ICU save your life?,Tue Mar 24, 2009 Landmark studies published in New England Journal of Medicine and CMAJ（Canadian Medical Association Journal）,This is the question a team of critical care physician researchers at VGH set out to answer several years ago. Their work is published today in the New England Journal of Medicine and Canadian Medical Association Journal (CMAJ). The results call for an urgent review of international clinical guidelines.,L to R: Investigator Dr. Vinay Dhingra discusses the SUGAR study with research coordinators Susan Logie and Laurie Smith along with Canadian project m