心内科医生应掌握的糖尿利病知识.pptVIP

?-细胞的胰岛素分泌调节 不同糖耐量状态个体在OGTT试验中的血糖曲线 Nomenclature and description term defined by FPG and 2hr PPG Nomenclature and description term defined by FPG and 2hr PPG Nomenclature and description term defined by FPG and 2hr PPG 空腹和餐后血糖增高的临床表现 Impaired glucose tolerance is a cardiovascular risk factor (Funagata Study) 糖尿病是冠心病的等位症 UKPDS研究中心梗与不同治疗间的关系 Introduction ± 30% of patients in surgical ICUs need 5 days intensive care (long-stay patients) Long-stay ICU patients 20% risk of death in ICU High morbidity due to specific complications Sepsis and inflammation Multiple organ failure Wasting, polyneuropathy, weakness Consume large fraction of scarce ICU resources Hyperglycaemia in ICU Current practice: Hyperglycaemia is common Caused by insulin resistance Adaptive? Only treated when blood glucose 215 mg/dL (12 mmol/L) Key hypothesis: Hyperglycaemia (110 mg/dL, 6.1 mmol/L) predisposes to specific ICU complications, prolonged intensive care dependency, and death Prospective, randomised, controlled trial All mechanically ventilated patients admitted to ICU Consent from closest family member Stratified for on-admission diagnosis and randomised to: Study design Protocol Standard feeding regimen started on admission Insulin by continuous i.v. infusion (syringe pump) Whole blood glucose monitored every 1 to 4 hours Insulin dose adjusted by ICU nurses and a study physician not involved in clinical decision making Primary outcome measure Death from any cause in ICU(cause of death confirmed by autopsy-blinded pathologist) Secondary outcome measures In-hospital mortality Study design Secondary outcome measures: morbidity Bloodstream infections* Inflammation* Acute renal failure and need for dialysis/haemofiltration* Anaemia and need for red-cell transfusions* Hyperbilirubinaemia* Critical illness polyneuropathy by weekly EMG screening* Prolonged (14 days) mechanical ventilation and ICU stay Costs (cumulative TISS) Data analysis Intention-to-treat analysis T