CAJ | 학술논문

自围术期高血糖与不良预后相关报道以来,关于围术期血糖管理问题就争论不休.虽然关于成年人的大量研究均证实危重患者高血糖发生率高,且高血糖会增加各种并发症及死亡的风险,而行胰岛素控制血糖会明显改善患者的预后.然而儿童糖代谢有别于成年人,特别是对于接受心脏直视手术的患儿,术中接受体外循环术,内环境发生改变,高血糖是否同样是危险因素,以及严格的血糖控制是否会带来益处等问题仍未达成共识.尽管目前关于儿童心脏直视手术围术期血糖管理问题仍存在诸多争议,但相关的回顾性分析及随机对照研究十分缺少,亟待更加完善、更大规模及人群的临床随机对照试验.
자위술기고혈당여불량예후상관보도이래,관우위술기혈당관리문제취쟁론불휴.수연관우성년인적대량연구균증실위중환자고혈당발생솔고,차고혈당회증가각충병발증급사망적풍험,이행이도소공제혈당회명현개선환자적예후.연이인동당대사유별우성년인,특별시대우접수심장직시수술적환인,술중접수체외순배술,내배경발생개변,고혈당시부동양시위험인소,이급엄격적혈당공제시부회대래익처등문제잉미체성공식.진관목전관우인동심장직시수술위술기혈당관리문제잉존재제다쟁의,단상관적회고성분석급수궤대조연구십분결소,극대경가완선、경대규모급인군적림상수궤대조시험.
The perioperative management of blood glucose has been controversial since clinical associations between hyperglycemia and adverse outcomes were fhrst reported.Many studies have demonstrated that hyperglycemia is a universal phenomenon in adults admitted to the ICU and it has been associated with increased morbidity and mortality,additionally,tight glycemic control with intensive insulin therapy in critically ill patients,including cardiac operation patients,significantly improves outcomes.But children's glycometabolism is different from adults',especially the ones who receive open-heart surgery with cardiopulmonary bypass for congenital heart disease,their internal enviroment chang a lot during pedoperative period,and whether hyperglycemia is associated with adverse outcomes after surgery and strict glycemic control is needed are still debatable in critically ill children.Although there are much dispute about perioperative management of glucose during openheart surgery in children,relevant researches are very limited,so further randomized controlled clinical trials are needed.