Гипергликемия критических состояний

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.

гипергликемия, критические состояния, стресс, инсулин

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