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Báo cáo y học: " Insulin: a wonder drug in the critically ill"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học General Psychiatry cung cấp cho các bạn kiến thức về ngành y đề tài: Insulin: a wonder drug in the critically ill? | Critical Care April 2002 Vol 6 No 2 Groeneveld et al. Commentary Insulin a wonder drug in the critically ill AB Johan Groeneveld Albertus Beishuizen and Frans C Visser Associate Professor Department of Intensive Care Institute of Cardiovascular Research Vrije Universiteit Medical Center Amsterdam The Netherlands Internist-Intensivist Department of Intensive Care Institute of Cardiovascular Research Vrije Universiteit Medical Center Amsterdam The Netherlands Professor Department of Cardiology Institute of Cardiovascular Research Vrije Universiteit Medical Center Amsterdam The Netherlands Correspondence AB Johan Groeneveld johan.groeneveld@vumc.nl Published online 8 February 2002 Critical Care 2002 6 102-105 2002 BioMed Central Ltd Print ISSN 1364-8535 Online ISSN 1466-609X Abstract Stress hyperglycaemia is a common event in acute critical illness. There is increasing evidence that maintaining normoglycaemia and treatment with insulin or with glucose-insulin-potassium GIK even in non-diabetic persons is helpful in limiting organ damage after myocardial infarction stroke traumatic brain injury and other conditions even though the conditions may be accompanied by insulin resistance. A landmark study now suggests that maintaining normoglycaemia with intensive insulin treatment in a heterogeneous population of critically ill patients decreases morbidity and mortality. The potential mechanisms that underlie such a beneficial effect are discussed. Keywords apoptosis pathways critically ill insulin ischaemia reperfusion stress hyperglycaemia Intensive care unit patients often have complex disorders. For instance bouts of inflammation trauma and ischaemia reperfusion may occur sequentially or synchronously in patients following surgery sepsis or shock thereby upregulating inflammatory and metabolic responses including cytokine release protein breakdown and insulin resistance 1-4 . In spite of elevated insulin levels insulin resistance at the receptor and postreceptor levels