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强化胰岛素治疗在重型颅脑创伤患者中的应用 被引量：3

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摘要 强化胰岛素治疗是一种将ICU重症患者的系统血糖严格控制在4.4～6.1mmol/L的胰岛素冲击疗法。该疗法在有效降低部分重症患者死亡率的同时,也增加了低血糖症的发生几率。重型颅脑创伤后出现系统循环血糖应激性升高并不意味大脑糖供给充足。在患者高血糖症出现的同时伴有相同程度的应激性颅内糖代谢率升高,脑组织供能需求增大。若此时使用强化胰岛素治疗将系统循环血糖控制在较低范围,将导致大脑摄糖不足,严重时则造成持续的大脑缺能量性代谢不良,影响患者预后。因此,治疗重型颅脑创伤患者时应慎重使用胰岛素控制血糖,将其波动范围更宽的定位在6.0～10.0mmol/L之间。
作者 徐杨 胡锦 周良辅
机构地区 上海交通大学附属第六人民医院神经外科 上海市急性创伤急救中心 复旦大学附属华山医院神经外科
出处 《国际神经病学神经外科学杂志》 2008年第5期417-420,共4页 Journal of International Neurology and Neurosurgery
基金 国家自然科学基金(30371454) 联合基金(GM)项目(30422201)资助
关键词 颅脑创伤 高血糖症 强化胰岛素治疗 预后
分类号 R651.1 [医药卫生—外科学]
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参考文献20

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同被引文献35

  • 1罗鉴亮,支兴刚.脑外伤急性期高血糖的临床意义[J].中华创伤杂志,2005,21(3):217-218. 被引量：26
  • 2许衍挺,赵湛,黄勇.严重脑外伤急性期血糖和血清胰岛素水平与病情及预后的关系[J].广东医学,2005,26(6):827-829. 被引量：4
  • 3Bhalla A, Tilling K, Kolominsky-Rabas P, et al. Variation in the management of acute physiological parameters after ischaemic stroke: a European perspective. Eur. J Neurol, 2003, 10(1):25-33.
  • 4Zygun DA, Steiner LA, Johnston AJ, et al. Hyperglycemia and brain tissue pH after traumatic brain injury. Neurosurgery, 2004, 55(4) :877-881.
  • 5Van den Berghe G, Wouters P, Weekers F, et al. Intensive insulin therapy in critically ill patients. N Engl J Med, 2001, 345(19) :1359-1367.
  • 6Van den Berghe G, Wilmer A, Hermans G, et al. Intensive insulin therapy in the medical ICU. N Engl J Med, 2006, 354(5) :449-461.
  • 7Gandhi GY, Nuttall GA, Abel MD, et al. Intensive intraoperative insulin therapy versus conventional glucose management during cardiac surgery: a randomized trial. Ann Intern Med, 2007, 146(4) :233-243.
  • 8Horan TC, Gaynes RP. Surveillance of nosocomial infections.In : Mayhall, C.G. ( Ed. ) , Hospital and Infection Control. 3rd ed. Lippincott Williams & Wilkins, Phladelphia, 2004: pp1659-1702.
  • 9Bilotta F, Caramia R, Cernak I, et al. Intensive insulin therapy after severe traumatic brain injury: a randomized clinical trial. Neurocrit Care, 2008, 9(2) : 159-166.
  • 10Cocster A, Neumann CR, Schmidt MI. Intensive insulin therapy in severe traumatic brain injury: a randomized tria. J Trauma, 2010, 68(4) :904-11.

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国际神经病学神经外科学杂志
2008年 第5期

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