ICU患者血糖的控制_培训课件.ppt

subgroup analyses With respect to 90-day mortality, subgroup analyses suggested no significant difference 90天死亡率亚组间没有显著差异 亚组死亡率 P值 手术/非手术 0.1 糖尿病 0.6 Severe sepsis 0.93 外伤 0.07 使用皮质激素 0.06 90天死亡率 0.02 最佳目标血糖水平 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(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 several questions? Header 为什么时隔仅仅8年，同样的强化血糖控制竟然有完全颠倒的两种结果？ Van den berge的鲁纹研究 和NICE SUGAR研究之间结论为何出现如此显著差异 NICE-SUGAR研究同样对监护医学领域始终在热捧的Bundle策略的推广和国际指南的制定有何影响？ 2009 2008 2001 Intensive insulin therapy SSC guidelines NICE SUGAR 相关述评 （一） March 26, 2009 美国内分泌协会 Finally, the rush to deploy difficult and resource-intensive protocols in ICU’s may be premature until there is a better understanding of the reasons that the NICE-SUGAR results differ so markedly from those of an earlier study by Van den Berghe et al. 在明确原因之前，贸然推动复杂且消耗资源的规章指南还为时尚早 We believe physicians should individually tailor their approach to glycemic control in their ICU patients, perhaps targeting glucose values between 144-180 mg/dl, until we better understand the reasons for these somewhat counterintuitive findings 在未阐明各项强化血糖控制研究结论为何出现如此显著差异之前，危重病血糖控制的目标还是订在144-180 mg/dl是合适 The Endocrine Society Statement to Providers on the Report Published in the New England Journal of Medicine on NICE-SUGAR March 26, 2009 mayo clinic proceedings 梅奥临床学报 澳大利亚和日本学者的联合述评 鲁纹大学van den berge第一次强化血糖控制研究存在的问题，例如非双盲;主要病种限于心外科患者;转入ICU后每日静脉糖量200-300g以及24小时内即开始PN\EN或混合喂养等非常规治疗，对照组术后病死率是澳大利亚的2倍；病死率如果未经校准可下降42%，这是任何治疗都无法达到的，低血糖的风险等  At that time, we chose not to highlight even more so