住院病人血糖管理课件.pptVIP

* 根据目前的共识，我们常把住院患者高血糖根据病因可分糖尿病导致的高血糖和应激性高血糖。一般来说应激反应性高血糖待应激因素解除后,血糖可恢复正常。院内高血糖患者根据病情程度又可分为危重患者和非危重患者。其中非危重患者包括糖尿病初诊，择期手术，合并妊娠的高血糖患者。危重病人是指合并感染，急诊手术和急性心脑血管疾病等严重应激时进入内/外科ICU治疗的高血糖患者。 * * 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。 * * 下表中列出了ADA和AACE对院内血糖控制目标建议： ADA推荐ICU患者的血糖控制应尽可能接近6.5mmol/L，一般 10.0mmol/L ；普通科室患者的血糖控制应尽可能接近 5.0—7.2mmol/L ，最高 10.0mmol/L AACE推荐ICU患者的血糖控制应6.5mmol/L，普通科室患者的血糖控制应为餐前6.5mmol/L， 最高10.0mmol/L * * * Based on the high rate of hypoglycemia and no difference in mortality in major trials, and the results of NICE –SUGAR that reported increased mortality… NEW TASK FORCE. The slide shows the recommendations for target glucose levels in critically ill patients in the intensive care setting, which were released on May 8, 2009, by the American Association of Clinical Endocrinologists and the American Diabetes Association, and published online in the June issues of Endocrine Practice and Diabetes Care. They include the following: Insulin therapy should be initiated for treatment of persistent hyperglycemia, starting at a threshold of no greater than 180 mg/dL. Once insulin therapy has been started, a glucose range of 140 to 180 mg/dL is recommended for the majority of critically ill patients. Intravenous insulin infusions are the preferred method for achieving and maintaining glycemic control in critically ill patients. Validated insulin infusion protocols with demonstrated safety and efficacy, and with low rates of occurrence of hypoglycemia, are recommended. With IV insulin therapy, frequent glucose monitoring is essential to minimize the occurrence of hypoglycemia and to achieve optimal glucose control. Moghissi ES, Korytkowski MT, Dinardo M, et al; AACE/ADA Inpatient Glycemic Control Consensus Panel. American Association of Clinical Endocrinologists and American Diabetes Association Consensus Statement on Inpatient Glycemic Control. Endocr Pract. 2009;15(4). /pub/pdf/guidelines/InpatientGlycemicControl