全院血糖管理马建华.ppt

全院血糖管理马建华 全院血糖管理马建华 重症监护病房的危重患者血糖持续10.0mmol/L时，应启动胰岛素治疗 若开始胰岛素治疗，对大多数患者来说血糖应维持在7.8~10.0mmol/L 胰岛素静脉输注治疗是危重患者控制和维持血糖的理想治疗方案 推荐采用行之有效的和保证安全的胰岛素输注方案，避免低血糖的发生 必须密切监测血糖，以达到最佳的血糖控制并避免低血糖 Moghissi ES, Korytkowski MT, DiNardo M, et al. American Association of Clinical Endocrinologists and American Diabetes Association consensus statement on inpatient glycemic control.Endocr Pract, 2009, 15: 353-369. * 这是一项回顾性、大样本研究，调查了2004年7月至9月期间37家医院的1718例住院患者，入选者符合以下至少一项标准：24小时内2次连续血糖180mg/dl，或住院期间接受胰岛素治疗。 研究表明，住院患者血糖控制状况不佳，连续两天血糖≥10mmol/L的患者比例约为50%，连续三天血糖≥10mmol/L的患者比例约为18%。 * 与血糖正常的住院患者相比，伴发高血糖的患者住院结局更差。 本研究目的是确定院内高血糖的患病率及住院患者合并高血糖（无论是否有糖尿病病史）的生存率、住院结局。研究回顾了1998年7月至10月期间乔治亚Baptist医学中心2030名内科及外科的住院患者，其中1886名患者纳入分析。新发生的高血糖定义为入院或住院期间FPG≥126 mg/dl（7 mmol/L），或2次及以上随机血糖≥200 mg/dl（11.1 mmol/L）。住院时，38%的患者伴发高血糖，其中26%已知糖尿病病史，12%无糖尿病病史。 结果显示，与血糖正常的住院患者相比，住院期间新发高血糖的患者的住院时间更长，分别为9.0天和4.5天（P 0.01）。 Admission hyperglycemia has been associatedwith increased hospital mortality in critically ill patients; however, it is not known whether hyperglycemia in patients admitted to general hospital wards is associated with poor outcome. The aim of this study was to determine the prevalence of in-hospital hyperglycemia and determine the survival and functional outcome of patients with hyperglycemia with and without a history of diabetes. We reviewed the medical records of 2030 consecutive adult patients admitted to Georgia Baptist Medical Center, a community teaching hospital in downtown Atlanta, GA, from July 1, 1998, to October 20, 1998. New hyperglycemia was defined as an admission or in-hospital fasting glucose level of 126 mg/dl (7 mmol/liter) or more or a random blood glucose level of 200 mg/dl (11.1 mmol/liter) 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 the admission. Newly discovered hyperglycemia was associated with higher in-hospital mortality rate