【正文】 血糖高于 215mg/dL(12 mmol/L)輸注胰島素 維持在 180~200mg/dL(10~11mmol/L) . Intensive insulin therapy in the critically ill patients (危重患者的強(qiáng)化胰島素治療 ) Van den Berghe G, et Engl J Med 2024。 血糖控制 強(qiáng)化胰島素治療 平均跟蹤 23天結(jié)局 強(qiáng)化胰島素 傳統(tǒng)治療 ICU死亡 5% 8% 住院死亡 7% 11% ICU留住 5天以上 11% 16% 機(jī)械通氣 14天以上 8% 12% 需血濾 /透析腎衰 5% 8% 血行感染 4% 8% 危重病多發(fā)性神經(jīng)病 29% 52% 第十三頁，共六十二頁。 345: 1359–1367. 入住后天數(shù) 入院后天數(shù) 住院生存率 ICU生存率 第十四頁，共六十二頁。 345: 1359–1367. 第十五頁，共六十二頁。 2024Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock ? remend that, following initial stabilization, patients with severe sepsis and hyperglycemia who are admitted to the ICU receive IV insulin therapy to reduce blood glucose levels (Grade 1B) ? 我們建議，初步穩(wěn)定后，發(fā)生高血糖的嚴(yán)重膿毒癥的 ICU患者應(yīng)接受靜脈胰島素治療來降低血糖水平 (Grade 1B) 第十七頁，共六十二頁。 ? remend that all patients receiving intravenous insulin receive a glucose calorie source and that blood glucose values be monitored every 1–2 hours until glucose values and insulin infusion rates are stable and then every 4 hours thereafter (Grade 1C) ? 我們建議，所有接受靜脈注射胰島素患者應(yīng)接受葡萄糖為熱量來源，并且每 12小時(shí)監(jiān)測血糖值，直到血糖水平和胰島素輸注率穩(wěn)定后每 4小時(shí)監(jiān)測血糖值 (Grade 1C) 2024Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock 第十九頁，共六十二頁。 Can controlling blood sugar levels in the ICU save your life? Tue Mar 24, 2024 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 manager Denise Foster. 控制血糖水平能拯救 ICU患者的生命嗎？ 發(fā)表在新英格蘭和 HCAMJ雜志上研究的里程碑 第二十一頁，共六十二頁。 NICE SUGAR研究 ： Two target ranges groups ? 強(qiáng)化胰島素治療組 the intensive (., tight) control ? 目標(biāo)血糖水平 81~108 mg/dL (~ mmol/L) ? 傳統(tǒng)治療組 the conventional control ? 目標(biāo)血糖水平 180mg/dL()及以下 第二十三頁，共六十二頁。 insulin administration was reduced and then discontinued if the blood glucose level dropped below 144 mg per deciliter ( mmol per liter). ? 在傳統(tǒng)治療組如果血糖水平超過 。如果血糖水平低于 ，然后停止 第二十四頁，共六十二頁。 第二十五頁，共六十二頁。 死亡率和生存時(shí)間 ? Niy days after randomization, 829 of 3010 patients (%) in the intensivecontrol group had died, as pared with 751 of 3012 patients (%) in the conventionalcontrol group ? 隨機(jī)分組后 90天， 強(qiáng)化胰島素治療組 3010例中的 829例〔 ％ 〕死亡，而傳統(tǒng)治療組 3012例中的 751例〔 ％ 〕死亡 ? The median survival time was lower in the intensivecontrol group than in the conventionalcontrol group ? 平均生存時(shí)間強(qiáng)化胰島素治療組低于傳統(tǒng)治療組 第二十七頁，共六十二頁。 95% confidence interval, to 。 ICU留住時(shí)間 ? During the 90day study period, there was no significant difference between the two groups in the median length of stay in the ICU ? 在 90天的研究期間， 2組 ICU平均留住時(shí)間沒有顯著差異 第二十九頁，共六十二頁。 第三十一頁，共六十二頁。 最佳答案目標(biāo)血糖水平 ? 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( mmol or less per liter) or less per deciliter resulted in lower mortality than did a target of 81 to 108 mg per deciliter( to mmol per liter). 這次大樣本國際隨機(jī)實(shí)驗(yàn)顯示：在 ICU患者強(qiáng)化胰島素治療增加死亡率，與， 10mmol/dl及以下的血糖水平能降低死亡率 ? On the basis of our results,