Crit Care:放松危重糖尿病患者的血糖控制目标,不会增加酮症酸中毒风险

2016-09-20 Seven L 译 MedSci原创

对危重糖尿病患者,放松血糖控制,是否会增加酮生产和酮症酸中毒?基于此,我们进行了研究,旨在评估放松危重糖尿病患者的血糖控制后,患者的酮症、酮尿和酮症酸中毒的发生情况。 本项前瞻性观察队列研究纳入了60例危重糖尿病患者,均来自澳大利亚某三级ICU病房。在ICU住院期间进行了血液和尿液中酮体检测。所有患者均不执行严格血糖控制,反而将血糖水平目标值(BGL)定在10-14mmol/l之间。入住IC

对危重糖尿病患者,放松血糖控制,是否会增加酮生产和酮症酸中毒?基于此,我们进行了研究,旨在评估放松危重糖尿病患者的血糖控制后,患者的酮症、酮尿和酮症酸中毒的发生情况。

本项前瞻性观察队列研究纳入了60例危重糖尿病患者,均来自澳大利亚某三级ICU病房。在ICU住院期间进行了血液和尿液中酮体检测。所有患者均不执行严格血糖控制,反而将血糖水平目标值(BGL)定在10-14mmol/l之间。入住ICU时,以及在ICU的每一天(最多连续10天),床旁定量检测血液中3-β-羟丁酸(β-OHB)含量,以及半定量检测尿液中酮体。

入住ICU时,平均血β-OHB水平为0.3 (0.1, 0.8) mmol/l。虽然酮症酸中毒是罕见的(3%),但是38例(63 %)在ICU住院早期出现了酮症(β-OHB ≥0.6 mmol/l)。血糖水平处于BGL以上或小于10 mmol/l的危重糖尿病患者,他们的酮血症、酮尿的患病率和严重程度无显著性差异。多变量线性回归分析显示,血酮水平和BGL、HbA1c、乳酸水平、红细胞压积、儿茶酚胺或APACHEⅢ评分之间没有关联。相反,体外循环术后血酮水平往往较高(P = 0.06  )。

对危重糖尿病患者,放松血糖控制,并不会增加酮生产和酮症酸中毒风险。此外,入院时存在酮症的患者,住院期间其酮症通常会在短期内迅速得到缓解。最后,体外循环手术可能是机体生产酮体的重要触发因素。

原始出处:

Nora Luethi,et al.Prevalence of ketosis, ketonuria, and ketoacidosis during liberal glycemic control in critically ill patients with diabetes: an observational study.Critical Care.Published: 15 September 2016

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    2016-09-22 mashirong
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    2016-09-21 段医生

    都想说啥意思

    0

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