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越来越多人关注到识别并区分应激性高血糖（SH）、新诊断高血糖和确诊糖尿病患者出现的高血糖三者的重要性。住院患者血糖控制被认为不仅仅影响住院花费，而且还影响患者的安全和治疗。住院患者高血糖发生率增加的原因包括之前存在糖尿病（DM）、未确诊DM或糖尿病前期、应激性高血糖、药物诱导的高血糖导致短暂性血糖波动。显然，无论之前是否诊断有DM，识别、描述住院患者的高血糖，并开始速效胰岛素治疗是非常重要的。关于高血糖最佳治疗目标的共识仍存在争议。对于重症监护病房患者，强化血糖管理的益处可能会因低血糖的代价而丧失。以肠内营养（EN）进行营养支持会增加重症和非重症住院患者高血糖风险。无论患者是新诊断糖尿病还是已确诊糖尿病，开始管饲喂养的原因是一样的。区别在于如何将EN纳入已确立的胰岛素管理方案中。使用EN带来的高血糖风险在之前诊断DM的患者中更高。本综述讨论了高血糖的发生率、发病机制、导致住院患者高血糖的因素、血糖管理目标、当前血糖管理推荐建议，和EN配方选择、使用和治疗的考虑因素。 Nutr Clin Pract. 2015;30(5):652-9. Management of Hyperglycemia and Enteral Nutrition in the Hospitalized Patient. Davidson P, Kwiatkowski CA, Wien M. West Chester University of Pennsylvania, West Chester, Pennsylvania. Monmouth Medical Center, Long Branch, New Jersey Rutgers University, School of Health Related Professions, Scotch Plains, New Jersey. Human Nutrition and Food Science Department, California State Polytechnic University, Pomona, California. There has been increased attention on the importance of identifying and distinguishing the differences between stress-induced hyperglycemia (SH), newly diagnosed hyperglycemia (NDH), and hyperglycemia in persons with established diabetes mellitus (DM). Inpatient blood glucose control is now being recognized as not only a cost issue for hospitals but also a concern for patient safety and care. The reasons for the increased incidence of hyperglycemia in hospitalized patients include preexisting DM, undiagnosed DM or prediabetes, SH, and medication-induced hyperglycemia with resulting transient blood glucose variability. It is clear that identifying and documenting hyperglycemia in hospitalized patients with and without a previous diagnosis of DM and initiating prompt insulin treatment are important. Agreement on the optimum treatment goals for hyperglycemia remains quite controversial, and the benefits of intensive glucose management may be lost at the cost of hypoglycemia in intensive care unit patients. Nutrition support in the form of enteral nutrition (EN) increases the risk of hyperglycemia in both critical and non-critically ill hospitalized patients. Reasons for beginning a tube feeding are the same whether a person has NDH or DM. What differs is how to incorporate EN into the established insulin management protocols. The risk for hyperglycemia with the addition of EN is even higher in those without a previous diagnosis of DM. This review discusses the incidence of hyperglycemia, the pathogenesis of hyperglycemia, factors contributing to hyperglycemia in the hospitalized patient, glycemic management goals, current glycemic management recommendations, and considerations for EN formula selection, administration, and treatment. KEYWORDS: critical illness; diabetes mellitus; enteral nutrition; hyperglycemia; nutritional support; prediabetic state PMID: 26084507 DOI: 10.1177/0884533615591057 翻译：天津市第三中心医院营养科肖慧娟 |
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