Stress-induced hyperglycemia.

摘要: Stress-induced hyperglycemia is a common problem in patients admitted to the ICU, even when glucose homeostasis has previously been normal. Hyperglycemia near-universal finding diabetic persons suffering catabolic illnesses and may worsen prognosis, although this possibility controversial. The presence of associated with an increased risk infectious complications surgical patients, indirect evidence indicates that maintenance euglycemia can reduce infection. causes stress include excessive counterregulatory hormones (glucagon, growth hormone, catecholamine, glucocorticoid, either endogenous or exogenous), high circulating tissue levels cytokine (in particular tumor necrosis factor-α [TNα] interleukin-1). This metabolic milieu results failure insulin suppress hepatic gluconeogenesis despite hyperglycemia; addition, insulin-mediated uptake into skeletal muscle impaired. Patients given nutritional support, especially by intravenous route, are particularly likely encounter hyperglycemia. Insulin remains obvious treatment for hyperglycemia, documenting clinical benefit aggressive therapy ICU sparse.