【正文】 es 無論有無糖尿病病史，應(yīng)用胰島素將血糖水平控制在110 mg/dL以下(yǐxi224。 345: 1359–1367.,第十五頁，共六十二頁。,2008Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock,1.We recommend 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(fāshēng)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。o)的方案來調(diào)整胰島素劑量，目標(biāo)血糖水平為 150 mg/dl (8.3mmol/L) (Grade 2C),2008Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock,第十八頁，共六十二頁。ny236。,4. We recommend that low glucose levels obtained with pointofcare testing of capillary blood be interpreted with caution, as such measurements may overestimate arterial blood or plasma glucose values (Grade 1B) 由手指血糖測(cè)得的低血糖水平應(yīng)持謹(jǐn)慎態(tài)度(t224。,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 manager Denise Foster.,控制血糖水平能拯救ICU患者(hu224。zh236。,NICE SUGAR研究(y225。y224。,NICE SUGAR研究(y225。t225。,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)。li225。應(yīng)用胰島素。,NICE SUGAR研究(y225。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。,第二十六頁，共六十二頁。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。)胰島素治療組3010例中的829例（ 27.5 ％ ）死亡，而傳統(tǒng)治療組3012例中的751例（ 24.9 ％ ）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, 1.01 to 1.23。nghu224。,ICU留住(li)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(sh237。,器官功能衰竭，機(jī)械(jīxi232。)通氣時(shí)間和腎臟替代療法沒有顯著差異,第三十頁，共六十二頁。,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。,最佳(zu236。nghu224。,several questions?,為什么時(shí)隔僅僅8年，同樣的強(qiáng)化血糖控制竟然有完全顛倒(diāndǎo)的兩種結(jié)果？ Van den berge的魯紋研究 和NICE SUGAR研究之間結(jié)論為何出現(xiàn)如此顯著差異 NICESUGAR研究同樣對(duì)監(jiān)護(hù)醫(yī)學(xué)領(lǐng)域始終在熱捧的Bundle策略的推廣和國際指南的制定有何影響？,2009,2008,2001,Intensive insulin therapy,SSC guidelines,NICE SUGAR,第三十四頁，共六十二頁。)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