重症患者血糖如何管理ppt培训课件

重症患者血糖如何管理内容(Coutline)。重症患者应激性高血糠E症患者的血糖管理a引。肠内营养与血糖管理症患者应激性高血精>1877年ClaudeBernard首次提出“stresshyperglycemia>是ICU病人很常见的代谢改变,不论既往是否有糖尿病>血糖升高与应激的严重程度相关_应急时三米物质代谢特点。L,糖代谢|。2,胆股动员f。3,蛋白质分解f合成|Critcareclin.2001jan;17(1);i107-24Stress-inducedhyperglycemiab一ICU内应激性高血糖(SHG)发生率高于普通病房Non-criticallyillmedical/surgical:33-38?612Intensivecareunits(ICU):2996-10068-Episodesofgiucase>110mg/dL:100%Episodesofglucose>200mg/dL:31%-Meanglucose>145mg/dL:39?4UnpenezGatalJCinEndoonoleabol200287878382LavelanCSelalDabelesCae189821246248KinseyJS.WayoCinPec2003781471-478FalsglaMelalCflCaneMed2008;3730013009SHG的发生机理甲状腺素个儿茶酚胺个壬/七妍尤迸胶峪素个脂高血糖素个胰岛素受体减少导致胰岛素不敏感而非胰岛素绝对量或相对量减少Critcareclin.2001jan;17(1);i107-24Stress-inducedhyperglycemiaSHG的特点么糖生成个速度:5mg/kg/min(正常财2mg/kg/min)么糖利用小速度受限,2-3mg/kg/min(即10963150miyn)无效循环:2-3倍于正常么血糖浓度增加,即应激性高血糗(SHOCnitcareclin.2001jan;17(1);107-24Stress-inducedhyperglycemia应激性高血糖对机体的影响J山1振杳中性粒翟胞与巨嘧细胞的杀伤能力及补体功能Critcareclin.2001jan;17(1);107-24Stress-inducedhyperglycemiaHyperglycemia:anindependentmarkerofin-hospitalmortalityinpatientswithundiagnoseddiabetes*TotalInpatientMortality30记20一不口5uo三1.7%63.0%0I明NommogbycemiaKnowndiabelesNewHypegbycemiaUnpenezeEalalJCnEnaoomnelMetabol20028778382HyperglycemiaandmortalityintheICU_Mix-ICU(Stamford)。回顾分析:Oct.t,1999Apr4,2002,n=1826心3X。一一一一八2Xsmmmmmmmmmmd80.99“100-119120-139140.159160-179180-199200-248250.299“>300MeanGlucose(mg/dL)kinseyJ5.Mgoac200378:1471-147845心山不当岛名巳日MortalityRate(o6)口吊