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  • 1 Borsod-Abaúj-Zemplén Megyei Kórház és Egyetemi Oktató Kórház Gyermekegészségügyi Továbbképző Intézet, IV. Gyermekosztály, Gyermek-Aneszteziológiai és Intenzív Osztály Miskolc Szentpéteri kapu 76. 3526
  • | 2 Debreceni Egyetem, Orvos- és Egészségtudományi Centrum Debrecen
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A stressz-hyperglykaemia számos kórállapot törvényszerű velejárója egyébként nem diabéteszes betegeknél, szignifikánsan befolyásolja a morbiditást és mortalitást. Célkitűzés: Felnőtt betegeknél prospektív tanulmányok igazolják mind független prediktorértékét, mind a normoglykaemia intenzív inzulinterápiával történő biztosításának túlélést javító hatását. Gyermekpopulációra vonatkozóan kevés az adat, egy retrospektív vizsgálatban kimutatták a hyperglykaemia tartama, intenzitása, csúcsértéke és a mortalitás közötti szignifikáns korrelációt. Betegek és módszerek: A szerzők multidiszciplináris gyermekintenzív osztályon retrospektív statisztikai elemzést végeztek a vércukorstátusz és a kórlefolyás közti korreláció meghatározása céljából. Eredmények: Megállapították, hogy legmagasabb vércukorérték bármely kórállapothoz társuló tragikus kimenetel (átlag: 14,38 mmol/l), és kimeneteltől függetlenül szepszis fennállása esetén fordult elő (átlag: 13,97 mmol/l). Az exitált betegek a kezelés teljes időtartama alatt (átlag: 7,59 mmol/l), és az utolsó kezelési napon is hyperglykaemiásak (átlag: 7,00 mmol/l), a túlélők a lefolyás során szignifikánsan kisebb mértékű vércukorszint-emelkedést mutattak (átlag: 6,52 mmol/l; p < 0,01), az emisszió napján pedig normoglykaemiásak (átlag: 5,28 mmol/l; p < 0,01) voltak. A > = 6,1 mmol/l vércukorszinttel járó kezelési napok százalékos aránya hasonlóan alakult túlélés és exitus esetén (42,68 vs 74,07; p < 0,01), a tragikus kimenetelű szepszisben bizonyult legnagyobb mértékűnek (átlag: 76,52%). Következtetés: Adataik alapján igazolták, hogy gyermekbetegek változó etiológiájú kritikus állapota – a felnőttekéhez hasonlóan – konzekvens hyperglykaemiát indukál, és a magasabb vércukorcsúcs, tartósabb, valamint intenzívebb hyperglykaemia nagyobb mortalitási kockázattal jár. A szepszist a szénhidrátanyagcsere-kisiklás potens induktorának találták.

  • Aarsland, A., Chinkes, D., Wolfe, R. R. és mtsai: Rate of hepatic very low density lipoprotein triglyceride secretion remains unchanged. Ann. Surg., 1996, 223 , 777–789.

    Wolfe R. R. , 'Rate of hepatic very low density lipoprotein triglyceride secretion remains unchanged ' (1996 ) 223 Ann. Surg. : 777 -789.

    • Search Google Scholar
  • Anderson, R. E., Tan, W. K., Martin, H. S. és mtsa: Effects of glucose and PaO 2 modulation on cortical intracellular acidosis, NADH redox state, and infarction in the ischemic penumbra. Stroke, 1999, 30 , 160–170.

    Martin H. S. , 'Effects of glucose and PaO2 modulation on cortical intracellular acidosis, NADH redox state, and infarction in the ischemic penumbra ' (1999 ) 30 Stroke : 160 -170.

    • Search Google Scholar
  • Bolton, C. F.: Sepsis and the systemic inflammatory response syndrome: neuromuscular manifestations. Crit. Care Med., 1996, 24 , 1408–1416.

    Bolton C. F. , 'Sepsis and the systemic inflammatory response syndrome: neuromuscular manifestations ' (1996 ) 24 Crit. Care Med. : 1408 -1416.

    • Search Google Scholar
  • Capes, S. E., Hunt, D., Malmerg, K. és mtsa: Stress hyperglycemia and increased risk of death after myocardial infarction in patients with and without diabetes: a systematic overview. Lancet, 2000, 355 , 773–778.

    Malmerg K. , 'Stress hyperglycemia and increased risk of death after myocardial infarction in patients with and without diabetes: a systematic overview ' (2000 ) 355 Lancet : 773 -778.

    • Search Google Scholar
  • Carter, E. A.: Insulin resistance in burns and trauma. Nutr. Rev., 1998, 56 (1 pt 2) , S170–176.

    Carter E. A. , 'Insulin resistance in burns and trauma ' (1998 ) 56 Nutr. Rev. : S170 -176.

  • Chew, W., Kucharczyk, J., Moseley, M. és mtsai: Hyperglycaemia augments ischemic brain injury: in vivo MR imaging/spectroscopic study with nicardipine in cats with occluded middle cerebral arteries. AJNR = Am. J. Neuroradiol., 1991, 12 , 603–609.

    Moseley M. , 'Hyperglycaemia augments ischemic brain injury: in vivo MR imaging/spectroscopic study with nicardipine in cats with occluded middle cerebral arteries ' (1991 ) 12 AJNR = Am. J. Neuroradiol. : 603 -609.

    • Search Google Scholar
  • Das, U. N.: Current advances in sepsis and septic shock with particular emphasis on the role of insulin. Med. Sci. Monit., 2003, 9 , RA 181–192.

    Das U. N. , 'Current advances in sepsis and septic shock with particular emphasis on the role of insulin ' (2003 ) 9 Med. Sci. Monit. : RA181 -RA192.

    • Search Google Scholar
  • Das, U. N.: Insulin and the critically ill. Crit. Care, 2002, 6 , 262–263.

    Das U. N. , 'Insulin and the critically ill ' (2002 ) 6 Crit. Care : 262 -263.

  • Davi, G., Catalano, I., Averna, M. és mtsai: Thromboxane biosynthesis and platelet function in type II diabetes mellitus. N. Engl. J. Med., 1990, 322 , 1769–1774.

    Averna M. , 'Thromboxane biosynthesis and platelet function in type II diabetes mellitus ' (1990 ) 322 N. Engl. J. Med. : 1769 -1774.

    • Search Google Scholar
  • Delamaire, M., Maugendre, D., Moreno, M. és mtsai: Impaired leukocyte functions in diabetic patients. Diabet. Med., 1997, 14 , 29–34.

    Moreno M. , 'Impaired leukocyte functions in diabetic patients ' (1997 ) 14 Diabet. Med. : 29 -34.

    • Search Google Scholar
  • Esmann, V.: The diabetic leukocyte. Enzyme, 1972, 13 , 32.

    Esmann V. , 'The diabetic leukocyte ' (1972 ) 13 Enzyme : 32 -.

  • Furnary, A. P., Zerr, K. J., Grunkemeier, G. L. és mtsa: Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures. Ann. Thorac. Surg., 1999, 67 , 352–362.

    Grunkemeier G. L. , 'Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures ' (1999 ) 67 Ann. Thorac. Surg. : 352 -362.

    • Search Google Scholar
  • Golden, S. J., Peart-Vigilance, C., Kao, W. H. és mtsa: Perioperative glycemic control and the risk of infectious complications in a cohort of adults with diabetes. Diabetes Care, 1999, 22 , 1408–1414.

    Kao W. H. , 'Perioperative glycemic control and the risk of infectious complications in a cohort of adults with diabetes ' (1999 ) 22 Diabetes Care : 1408 -1414.

    • Search Google Scholar
  • Hansen, T. K., Thiel, S., Wouters, P. J. és mtsai: Intensive insulin therapy exerts anti-inflammatory effects in critically ill patients and counteracts the adverse effect of low mannose-binding lectin levels. J. Clin. Endocrinol. Metab., 2003, 88 , 1082–1088.

    Wouters P. J. , 'Intensive insulin therapy exerts anti-inflammatory effects in critically ill patients and counteracts the adverse effect of low mannose-binding lectin levels ' (2003 ) 88 J. Clin. Endocrinol. Metab. : 1082 -1088.

    • Search Google Scholar
  • Hostetter, M. K.: Handicaps to host defense. Effects of hyperglycemia on C3 and Candida albicans. Diabetes, 1990, 39 , 271–275.

    Hostetter M. K. , 'Handicaps to host defense. Effects of hyperglycemia on C3 and Candida albicans ' (1990 ) 39 Diabetes : 271 -275.

    • Search Google Scholar
  • Hotamisligil, G. S., Spiegelman, B. M.: Tumor necrosis factor alpha: a key component of the obesity-diabetes link. Diabetes, 1994, 43 , 1271–1278.

    Spiegelman B. M. , 'Tumor necrosis factor alpha: a key component of the obesity-diabetes link ' (1994 ) 43 Diabetes : 1271 -1278.

    • Search Google Scholar
  • Jain, S. K., Nagi, D. K., Slavin, B. M. és mtsai: Insulin therapy in type 2 diabetic subjects suppresses plasminogen activator inhibitor (PAI-1) activity and proinsulin-like molecules independently of glycaemic control. Diabet. Med., 1993, 10 , 27–32.

    Slavin B. M. , 'Insulin therapy in type 2 diabetic subjects suppresses plasminogen activator inhibitor (PAI-1) activity and proinsulin-like molecules independently of glycaemic control ' (1993 ) 10 Diabet. Med. : 27 -32.

    • Search Google Scholar
  • Jeevanandam, M., Young, D. H., Schiller, W. R.: Glucose turnover, oxidation, and indices of recycling in severely traumatized patients. J. Trauma Inj. Infec. Crit. Care, 1990, 30 , 582–589.

    Schiller W. R. , 'Glucose turnover, oxidation, and indices of recycling in severely traumatized patients ' (1990 ) 30 J. Trauma Inj. Infec. Crit. Care : 582 -589.

    • Search Google Scholar
  • Jeschke, M. G., Einspanier, R., Klein, D. és mtsai: Insulin attenuates the systemic inflammatory response to thermal trauma. Mol. Med., 2002, 8 , 443–450.

    Klein D. , 'Insulin attenuates the systemic inflammatory response to thermal trauma ' (2002 ) 8 Mol. Med. : 443 -450.

    • Search Google Scholar
  • Jeschke, M. G., Klein, D., Herndon, D. N.: Insulin Treatment Improves the Systemic Inflammatory Reaction to Severe Trauma. Ann. Surg., 2004, 239 , 553–560.

    Herndon D. N. , 'Insulin Treatment Improves the Systemic Inflammatory Reaction to Severe Trauma ' (2004 ) 239 Ann. Surg. : 553 -560.

    • Search Google Scholar
  • Kang, B. P., Frencher, S., Reddy, V. és mtsai: High glucose promotes mesangial cell apoptosis by oxidant-dependent mechanism. Am. J. Physiol. Renal Physiol., 2003, 284 , F455–F466.

    Reddy V. , 'High glucose promotes mesangial cell apoptosis by oxidant-dependent mechanism ' (2003 ) 284 Am. J. Physiol. Renal Physiol. : F455 -F466.

    • Search Google Scholar
  • Krinsley, J. S.: Association between hpyerglycemia and increased hospital mortality in a heterogeneous population of critically ill patients. Mayo Clin. Proc., 2003, 78 , 1471–1478.

    Krinsley J. S. , 'Association between hpyerglycemia and increased hospital mortality in a heterogeneous population of critically ill patients ' (2003 ) 78 Mayo Clin. Proc. : 1471 -1478.

    • Search Google Scholar
  • Lattermann, R., Schricker, T., Wachter, U. és mtsai: Understanding the mechanisms by wich isoflurane modifies the hyperglycemic response to surgery. Anesth. Analg., 2001, 93 , 121–127.

    Wachter U. , 'Understanding the mechanisms by wich isoflurane modifies the hyperglycemic response to surgery ' (2001 ) 93 Anesth. Analg. : 121 -127.

    • Search Google Scholar
  • Leijten, F. S. S., Weerd, de, A. W.: Critical illness polyneuropathy: a review of the literature, definition and pathophysiology. Clin. Neurol. Neurosurg., 1994, 96 , 10–19.

    Weerd A. W. , 'Critical illness polyneuropathy: a review of the literature, definition and pathophysiology ' (1994 ) 96 Clin. Neurol. Neurosurg. : 10 -19.

    • Search Google Scholar
  • Leroux, J. P., Marchand, J. C., Hong Tuan, H. R. és mtsa: The influence of insulin on glucose permeability and metabolism of human granulocytes. Eur. J. Biochem., 1975, 58 , 367.

    Hong Tuan H. R. , 'The influence of insulin on glucose permeability and metabolism of human granulocytes ' (1975 ) 58 Eur. J. Biochem. : 367 -.

    • Search Google Scholar
  • Lewis, K. S.: Intensive Insulin Therapy for Critically Ill Patients. Ann. Pharmacother., 2004, 38 (7) , 1243–1251.

    Lewis K. S. , 'Intensive Insulin Therapy for Critically Ill Patients ' (2004 ) 38 Ann. Pharmacother. : 1243 -1251.

    • Search Google Scholar
  • MacCuish, A. C., Urbaniak, S. J., Campbell, C. J.: Phytohemagglutinin transformation and circulating lymphocyte subpopulation in insulin-dependent diabetic patients. Diabetes, 1974, 23 , 708.

    Campbell C. J. , 'Phytohemagglutinin transformation and circulating lymphocyte subpopulation in insulin-dependent diabetic patients ' (1974 ) 23 Diabetes : 708 -.

    • Search Google Scholar
  • MacRury, S. M., Gemmell, C. G., Paterson, K. R. és mtsa: Changes in phagocytic function with glycaemic control in diabetic patients. J. Clin. Pathol., 1989, 42 , 1143–1147.

    Paterson K. R. , 'Changes in phagocytic function with glycaemic control in diabetic patients ' (1989 ) 42 J. Clin. Pathol. : 1143 -1147.

    • Search Google Scholar
  • Malmberg, K., Ryden, L., Efendic, S. és mtsai: Randomized trial of insulin-glucose infusion followed by subcutaneous insulin treatment in diabetic patients with acute myocardial infarction (DIGAMI study): effects on mortality at 1 years. J. Am. Coll. Cardiol., 1995, 26 , 57–65.

    Efendic S. , 'Randomized trial of insulin-glucose infusion followed by subcutaneous insulin treatment in diabetic patients with acute myocardial infarction (DIGAMI study): effects on mortality at 1 years ' (1995 ) 26 J. Am. Coll. Cardiol. : 57 -65.

    • Search Google Scholar
  • Oliver, M. F., Opie, L. H.: Effects of glucose and fatty acids on myocardial ischaemia and arrhythmias. Lancet, 1994, 343 , 155–158.

    Opie L. H. , 'Effects of glucose and fatty acids on myocardial ischaemia and arrhythmias ' (1994 ) 343 Lancet : 155 -158.

    • Search Google Scholar
  • Osier, F. H. A., Berkley, J. A., Ross, A. és mtsai: Abnormal blood glucose concentrations on admission to a rural Kenyan district hospital: prevalence and outcome. Arch. Dis. Childhood, 2003, 88 , 621–625.

    Ross A. , 'Abnormal blood glucose concentrations on admission to a rural Kenyan district hospital: prevalence and outcome ' (2003 ) 88 Arch. Dis. Childhood : 621 -625.

    • Search Google Scholar
  • Rayfield, E. J., Ault, M. J., Keusch, G. T. és mtsai: Infection and diabetes. Am. J. Med., 1982, 72 , 439–450.

    Keusch G. T. , 'Infection and diabetes ' (1982 ) 72 Am. J. Med. : 439 -450.

  • Sakurai, Y., Aarsland, A., Herndon, D. N. és mtsai: Stimulation of muscle protein synthesis by long-term insulin infusion in severely burned patients. Ann. Surg., 1995, 222 , 283–297.

    Herndon D. N. , 'Stimulation of muscle protein synthesis by long-term insulin infusion in severely burned patients ' (1995 ) 222 Ann. Surg. : 283 -297.

    • Search Google Scholar
  • Sieber, F. E., Traystman, R. J.: Special issues: glucose and the brain. Crit. Care Med., 1992, 20 , 104–114.

    Traystman R. J. , 'Special issues: glucose and the brain ' (1992 ) 20 Crit. Care Med. : 104 -114.

    • Search Google Scholar
  • Srinivasan, V., Spinella, P. C., Drott, H. R. és mtsai: Association of timing, duration, and intensity of hyperglycemia with intensive care unit mortality in critically ill children. Pediatr. Crit. Care Med., 2004, 5 , 329–336.

    Drott H. R. , 'Association of timing, duration, and intensity of hyperglycemia with intensive care unit mortality in critically ill children ' (2004 ) 5 Pediatr. Crit. Care Med. : 329 -336.

    • Search Google Scholar
  • Berghe, van den, G., Wouters, P., Weekers, F. és mtsai: Intensive insulin therapy in critically ill patients. N. Engl. J. Med., 2001, 345 , 1359–1367.

    Weekers F. , 'Intensive insulin therapy in critically ill patients ' (2001 ) 345 N. Engl. J. Med. : 1359 -1367.

    • Search Google Scholar
  • Zerr, K. J., Furnary, A. P., Grunkemeier, G. L. és mtsai: Glucose control lowers the risk of wound infection in diabetics after open heart operations. Ann. Thorac. Surg., 1997, 63 , 352–361.

    Grunkemeier G. L. , 'Glucose control lowers the risk of wound infection in diabetics after open heart operations ' (1997 ) 63 Ann. Thorac. Surg. : 352 -361.

    • Search Google Scholar
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