{"title":"强化胰岛素治疗对应激性高血糖危重患者动态心功能的影响。","authors":"Yu-Dan Wang, Jing-Jing Yu","doi":"10.4239/wjd.v16.i7.107767","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Stress-induced hyperglycemia (SIH) is common in critically ill patients and has been associated with adverse cardiovascular outcomes. Intensive insulin therapy (IIT) has been proposed to mitigate these risks by achieving tighter glycemic control.</p><p><strong>Aim: </strong>To evaluate the efficacy of IIT for managing SIH in critically ill patients and to explore its potential effect on cardiac function.</p><p><strong>Methods: </strong>A retrospective study was conducted at our hospital from January 2021 to December 2024, adhering to STROBE guidelines. A total of 186 critically ill patients were divided into normal glycemia (<i>n</i> = 85) and SIH (<i>n</i> = 101) groups. The SIH cohort was further subdivided into conventional treatment (<i>n</i> = 50) and IIT (<i>n</i> = 51) groups. Hemodynamic parameters-including right atrial pressure (RAP), pulmonary artery pressure (PAP), pulmonary capillary wedge pressure (PAWP), cardiac output (CO), cardiac index (CI), and B-type natriuretic peptide (BNP)-were measured at baseline and post-treatment. Clinical outcomes such as intensive care unit (ICU) length of stay, mechanical ventilation requirements, and mortality were also recorded. Statistical analyses were conducted using independent samples <i>t</i>-tests and <i>χ</i> <sup>2</sup>/Fisher's exact tests.</p><p><strong>Results: </strong>SIH markedly worsened haemodynamics versus normal glycaemia: RAP 9.8 ± 5.1 <i>vs</i> 6.1 ± 3.5 mmHg, PAP 35.2 ± 16.0 <i>vs</i> 26.2 ± 10.3 mmHg, PAWP 16.0 ± 7.0 <i>vs</i> 8.6 ± 6.4 mmHg, CO 3.3 ± 2.3 <i>vs</i> 6.0 ± 3.3 L/min, CI 1.88 ± 0.24 <i>vs</i> 2.70 ± 0.50 L/min/m<sup>2</sup>, BNP 465 ± 250 <i>vs</i> 180 ± 53 pg/mL (all <i>P</i> < 0.001). Within the SIH cohort, IIT outperformed conventional therapy: RAP 7.0 ± 2.2 <i>vs</i> 8.3 ± 3.9 mmHg (<i>P</i> = 0.04), PAP 21.6 ± 3.7 <i>vs</i> 29.3 ± 6.5 mmHg (<i>P</i> < 0.001), PAWP 10.2 ± 5.4 <i>vs</i> 13.8 ± 5.3 mmHg (<i>P</i> = 0.001), CO 4.9 ± 2.2 <i>vs</i> 4.0 ± 1.4 L/min (<i>P</i> = 0.022), CI 2.58 ± 0.32 <i>vs</i> 2.11 ± 0.31 L/min/m<sup>2</sup>, <i>P</i> < 0.001), BNP 202 ± 62 <i>vs</i> 346 ± 171 pg/mL (<i>P</i> < 0.001). Clinically, IIT shortened ICU stay (10.3 ± 3.4 <i>vs</i> 14.5 ± 2.6 days, <i>P</i> < 0.001), reduced ventilator use (56.9% <i>vs</i> 76.0%, <i>P</i> = 0.042), and lowered mortality (23.5% <i>vs</i> 42.0%, <i>P</i> = 0.048).</p><p><strong>Conclusion: </strong>IIT significantly reduced cardiac filling pressures, improved cardiac function, and was associated with favorable clinical outcomes in SIH patients, suggesting potential benefits of stricter glycaemic control in critically ill patients. However, given the retrospective design and absence of glucose-variability monitoring, these findings should be interpreted with caution.</p>","PeriodicalId":48607,"journal":{"name":"World Journal of Diabetes","volume":"16 7","pages":"107767"},"PeriodicalIF":4.2000,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12278089/pdf/","citationCount":"0","resultStr":"{\"title\":\"Impact of intensive insulin therapy on dynamic cardiac function in critically ill patients with stress-induced hyperglycemia.\",\"authors\":\"Yu-Dan Wang, Jing-Jing Yu\",\"doi\":\"10.4239/wjd.v16.i7.107767\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Stress-induced hyperglycemia (SIH) is common in critically ill patients and has been associated with adverse cardiovascular outcomes. Intensive insulin therapy (IIT) has been proposed to mitigate these risks by achieving tighter glycemic control.</p><p><strong>Aim: </strong>To evaluate the efficacy of IIT for managing SIH in critically ill patients and to explore its potential effect on cardiac function.</p><p><strong>Methods: </strong>A retrospective study was conducted at our hospital from January 2021 to December 2024, adhering to STROBE guidelines. A total of 186 critically ill patients were divided into normal glycemia (<i>n</i> = 85) and SIH (<i>n</i> = 101) groups. The SIH cohort was further subdivided into conventional treatment (<i>n</i> = 50) and IIT (<i>n</i> = 51) groups. Hemodynamic parameters-including right atrial pressure (RAP), pulmonary artery pressure (PAP), pulmonary capillary wedge pressure (PAWP), cardiac output (CO), cardiac index (CI), and B-type natriuretic peptide (BNP)-were measured at baseline and post-treatment. Clinical outcomes such as intensive care unit (ICU) length of stay, mechanical ventilation requirements, and mortality were also recorded. Statistical analyses were conducted using independent samples <i>t</i>-tests and <i>χ</i> <sup>2</sup>/Fisher's exact tests.</p><p><strong>Results: </strong>SIH markedly worsened haemodynamics versus normal glycaemia: RAP 9.8 ± 5.1 <i>vs</i> 6.1 ± 3.5 mmHg, PAP 35.2 ± 16.0 <i>vs</i> 26.2 ± 10.3 mmHg, PAWP 16.0 ± 7.0 <i>vs</i> 8.6 ± 6.4 mmHg, CO 3.3 ± 2.3 <i>vs</i> 6.0 ± 3.3 L/min, CI 1.88 ± 0.24 <i>vs</i> 2.70 ± 0.50 L/min/m<sup>2</sup>, BNP 465 ± 250 <i>vs</i> 180 ± 53 pg/mL (all <i>P</i> < 0.001). Within the SIH cohort, IIT outperformed conventional therapy: RAP 7.0 ± 2.2 <i>vs</i> 8.3 ± 3.9 mmHg (<i>P</i> = 0.04), PAP 21.6 ± 3.7 <i>vs</i> 29.3 ± 6.5 mmHg (<i>P</i> < 0.001), PAWP 10.2 ± 5.4 <i>vs</i> 13.8 ± 5.3 mmHg (<i>P</i> = 0.001), CO 4.9 ± 2.2 <i>vs</i> 4.0 ± 1.4 L/min (<i>P</i> = 0.022), CI 2.58 ± 0.32 <i>vs</i> 2.11 ± 0.31 L/min/m<sup>2</sup>, <i>P</i> < 0.001), BNP 202 ± 62 <i>vs</i> 346 ± 171 pg/mL (<i>P</i> < 0.001). Clinically, IIT shortened ICU stay (10.3 ± 3.4 <i>vs</i> 14.5 ± 2.6 days, <i>P</i> < 0.001), reduced ventilator use (56.9% <i>vs</i> 76.0%, <i>P</i> = 0.042), and lowered mortality (23.5% <i>vs</i> 42.0%, <i>P</i> = 0.048).</p><p><strong>Conclusion: </strong>IIT significantly reduced cardiac filling pressures, improved cardiac function, and was associated with favorable clinical outcomes in SIH patients, suggesting potential benefits of stricter glycaemic control in critically ill patients. However, given the retrospective design and absence of glucose-variability monitoring, these findings should be interpreted with caution.</p>\",\"PeriodicalId\":48607,\"journal\":{\"name\":\"World Journal of Diabetes\",\"volume\":\"16 7\",\"pages\":\"107767\"},\"PeriodicalIF\":4.2000,\"publicationDate\":\"2025-07-15\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12278089/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"World Journal of Diabetes\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.4239/wjd.v16.i7.107767\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ENDOCRINOLOGY & METABOLISM\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"World Journal of Diabetes","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.4239/wjd.v16.i7.107767","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ENDOCRINOLOGY & METABOLISM","Score":null,"Total":0}
引用次数: 0
摘要
背景：应激性高血糖症（SIH）在危重患者中很常见，并与不良心血管结局相关。强化胰岛素治疗（IIT）已被建议通过实现更严格的血糖控制来减轻这些风险。目的：评价IIT治疗危重患者SIH的疗效，探讨其对心功能的潜在影响。方法：遵循STROBE指南，于2021年1月至2024年12月在我院进行回顾性研究。186例危重患者分为血糖正常组（n = 85）和SIH组（n = 101）。SIH队列进一步细分为常规治疗组（n = 50）和IIT组（n = 51）。血流动力学参数-包括右心房压（RAP）、肺动脉压（PAP）、肺毛细血管楔压（PAWP）、心输出量（CO）、心脏指数（CI）和b型利钠肽(BNP)-在基线和治疗后测量。临床结果，如重症监护病房（ICU）住院时间、机械通气要求和死亡率也被记录。采用独立样本t检验和χ 2/Fisher精确检验进行统计分析。结果：与正常血糖相比，SIH显著恶化了血流动力学：RAP 9.8±5.1 vs 6.1±3.5 mmHg, PAP 35.2±16.0 vs 26.2±10.3 mmHg, paap 16.0±7.0 vs 8.6±6.4 mmHg, CO 3.3±2.3 vs 6.0±3.3 L/min, CI 1.88±0.24 vs 2.70±0.50 L/min/m2, BNP 465±250 vs 180±53 pg/mL（均P < 0.001）。在SIH队列中，IIT优于常规治疗：RAP 7.0±2.2 vs 8.3±3.9 mmHg (P = 0.04), PAP 21.6±3.7 vs 29.3±6.5 mmHg (P < 0.001), PAWP 10.2±5.4 vs 13.8±5.3 mmHg (P = 0.001), CO 4.9±2.2 vs 4.0±1.4 L/min (P = 0.022), CI 2.58±0.32 vs 2.11±0.31 L/min/m2, P < 0.001), BNP 202±62 vs 346±171 pg/mL （P < 0.001）。临床方面，IIT缩短了ICU住院时间（10.3±3.4 vs 14.5±2.6天，P < 0.001），减少了呼吸机使用（56.9% vs 76.0%, P = 0.042），降低了死亡率（23.5% vs 42.0%, P = 0.048）。结论：IIT可显著降低SIH患者的心脏充盈压力，改善心功能，并与良好的临床结果相关，提示对危重患者进行更严格的血糖控制可能有益。然而，考虑到回顾性设计和缺乏血糖变异性监测，这些发现应谨慎解释。
Impact of intensive insulin therapy on dynamic cardiac function in critically ill patients with stress-induced hyperglycemia.
Background: Stress-induced hyperglycemia (SIH) is common in critically ill patients and has been associated with adverse cardiovascular outcomes. Intensive insulin therapy (IIT) has been proposed to mitigate these risks by achieving tighter glycemic control.
Aim: To evaluate the efficacy of IIT for managing SIH in critically ill patients and to explore its potential effect on cardiac function.
Methods: A retrospective study was conducted at our hospital from January 2021 to December 2024, adhering to STROBE guidelines. A total of 186 critically ill patients were divided into normal glycemia (n = 85) and SIH (n = 101) groups. The SIH cohort was further subdivided into conventional treatment (n = 50) and IIT (n = 51) groups. Hemodynamic parameters-including right atrial pressure (RAP), pulmonary artery pressure (PAP), pulmonary capillary wedge pressure (PAWP), cardiac output (CO), cardiac index (CI), and B-type natriuretic peptide (BNP)-were measured at baseline and post-treatment. Clinical outcomes such as intensive care unit (ICU) length of stay, mechanical ventilation requirements, and mortality were also recorded. Statistical analyses were conducted using independent samples t-tests and χ2/Fisher's exact tests.
Results: SIH markedly worsened haemodynamics versus normal glycaemia: RAP 9.8 ± 5.1 vs 6.1 ± 3.5 mmHg, PAP 35.2 ± 16.0 vs 26.2 ± 10.3 mmHg, PAWP 16.0 ± 7.0 vs 8.6 ± 6.4 mmHg, CO 3.3 ± 2.3 vs 6.0 ± 3.3 L/min, CI 1.88 ± 0.24 vs 2.70 ± 0.50 L/min/m2, BNP 465 ± 250 vs 180 ± 53 pg/mL (all P < 0.001). Within the SIH cohort, IIT outperformed conventional therapy: RAP 7.0 ± 2.2 vs 8.3 ± 3.9 mmHg (P = 0.04), PAP 21.6 ± 3.7 vs 29.3 ± 6.5 mmHg (P < 0.001), PAWP 10.2 ± 5.4 vs 13.8 ± 5.3 mmHg (P = 0.001), CO 4.9 ± 2.2 vs 4.0 ± 1.4 L/min (P = 0.022), CI 2.58 ± 0.32 vs 2.11 ± 0.31 L/min/m2, P < 0.001), BNP 202 ± 62 vs 346 ± 171 pg/mL (P < 0.001). Clinically, IIT shortened ICU stay (10.3 ± 3.4 vs 14.5 ± 2.6 days, P < 0.001), reduced ventilator use (56.9% vs 76.0%, P = 0.042), and lowered mortality (23.5% vs 42.0%, P = 0.048).
Conclusion: IIT significantly reduced cardiac filling pressures, improved cardiac function, and was associated with favorable clinical outcomes in SIH patients, suggesting potential benefits of stricter glycaemic control in critically ill patients. However, given the retrospective design and absence of glucose-variability monitoring, these findings should be interpreted with caution.
期刊介绍：
The WJD is a high-quality, peer reviewed, open-access journal. The primary task of WJD is to rapidly publish high-quality original articles, reviews, editorials, and case reports in the field of diabetes. In order to promote productive academic communication, the peer review process for the WJD is transparent; to this end, all published manuscripts are accompanied by the anonymized reviewers’ comments as well as the authors’ responses. The primary aims of the WJD are to improve diagnostic, therapeutic and preventive modalities and the skills of clinicians and to guide clinical practice in diabetes. Scope: Diabetes Complications, Experimental Diabetes Mellitus, Type 1 Diabetes Mellitus, Type 2 Diabetes Mellitus, Diabetes, Gestational, Diabetic Angiopathies, Diabetic Cardiomyopathies, Diabetic Coma, Diabetic Ketoacidosis, Diabetic Nephropathies, Diabetic Neuropathies, Donohue Syndrome, Fetal Macrosomia, and Prediabetic State.
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