diaendoСахарный диабетDiabetes mellitus2072-03512072-0378Endocrinology research centre10.14341/DM2015133-41diaendo-6787Research ArticleВопросы патогенезаPathogenesisГипергликемия критических состоянийHyperglycaemia in criticaly ill patientsКлыпаТатьяна ВалерьевнаKlypaTatiana Valer'evna

кандидат медицинских наук, заведующая отделением анестезиологии-реанимации Центра Сердечно-сосудистой хирургии

MD, PhD, The head of Anesthesiology and ICU department

klypa@hotbox.ruОреховаМария СергеевнаOrehovaMaria Sergeevna

Врач анестезиолог-реаниматолог отделения анестезиологии-реанимации Центра Сердечно-сосудистой хирургии

MD, Anesthesiology and ICU department

mysterylife@rambler.ruЗабросаеваЛюдмила ИвановнаZabrosaevaLudmila Ivanovna

Кандидат медицинских наук, доцент кафедры биохимии

MD, PhD, associate professor, Biochemistry chair

askold@list.ruФГБУЗ Клиническая больница № 119 ФМБА, МоскваРоссияClinical Hospital №119, MoscowRussian FederationГБОУ ВПО "Смоленская государственная медицинская академия" Минздрава России, СмоленскРоссияSmolensk State Medical Academy, SmolenskRussian Federation2015180320151813341Copyright © Клыпа Т.В., Орехова М.С., Забросаева Л.И., 20152015Клыпа Т.В., Орехова М.С., Забросаева Л.И.Klypa T.V., Orehova M.S., Zabrosaeva L.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.dia-endojournals.ru/jour/article/view/6787

Обзор литературы посвящен вопросу стрессовой гипергликемии (ГГ). Актуальность проблемы основывается на значимой взаимосвязи между ГГ стресса и увеличением количества осложнений и летальности больных в критическом состоянии. Рассмотрены патофизиологические механизмы синдрома стрессовой ГГ и ее составляющих ? острых гипергликемий, инсулинорезистентности и гиперинсулинемии. Освещен спектр критических состояний, для которых наиболее характерно развитие стрессовой ГГ, а также ее негативное воздействие на различные органы и системы. Рассмотрена клиническая значимость стресс-ГГ, ее влияние на результаты лечения и развитие осложнений. Представлены данные о том, что контроль и адекватная коррекция ГГ приводят к улучшению результатов лечения, а контроль метаболизма глюкозы является одним из основных факторов, определяющих исходы критических состояний у всех категорий больных, а не только у больных сахарным диабетом (СД). Особое внимание в обзоре уделено вопросам своевременной диагностики состояния углеводного обмена в медицине критических состояний, а также профилактике и своевременной коррекции выраженной ГГ. Дискутируются вопросы вариантов выбора коррекции ГГ, целевые показатели гликемии и различные терапевтические методики ее коррекции. В основном освещено состояние проблемы в отделениях реанимации и интенсивной терапии.

The review highlights the problem of stress-induced hyperglycaemia (IT). The study of this condition is in demand because there is an association between IT and increasing number of complications and mortality among patients in critical state. In the review pathological and physiological mechanisms of stress-induced IT syndrome and its components are shown. These are acute IT, insulin resistance and hyperinsulinemia. The range of critical states, in which development of stress-induced IT is more probable and the IT negative impact on different organs and systems are described in the article. Clinical significance, influence on treatment and complications development of stress-induced IT are considered. It has been shown that adequate control and correction of IT are leading to improvement in critically ill patients state. Much attention in the review is paid to early diagnostics of any carbohydrate abnormalities in critical care medicine, as well as to prevention and optimal correction of IT. The variety of IT correction methods, target glucose levels and various therapeutic methods of hyperglycaemia correction are discussed. Dealing with hyperglycaemia in intensive care units is described in details.

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The authors declare that there are no conflicts of interest present.