住院病人的血糖管理精品.pptVIP

总结 住院患者高血糖常见，严重高血糖常伴有更高死亡率和并发症； 严格控制血糖在很大程度上增加了低血糖的发生 对住院患者在控制高血糖的同时应避免低血糖的发生； 目前许多专业组织对住院患者都推荐在严格控制血糖的同时避免低血糖的发生 * * 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. * 研究表明，住院患者血糖控制状况不佳，连续两天血糖≥180mg/dl的患者比例约为50%，连续三天血糖≥180mg/dl的患者比例约为18%. * * 研究提示，1886例危重患者中，高血糖是患者（无论有无糖尿病病史）预后较差及高死亡率的重要指标。住院且发生高血糖的患者中，既往无糖尿病病史，即新发现高血糖者死亡率为16%，既往有糖尿病史的患者死亡率为3%，正常血糖患者的死亡率为1.7%。 发生率 病死率 p值 高血糖