Blutzucker in der Intensivmedizin

Zusammenfassung

Eine stressbedingte Hyperglykämie und eine Insulinresistenz sind bei kritisch kranken Patienten überaus häufig anzutreffen, insbesondere in Verbindung mit septischen Zustandsbildern. Verschiedene pathogenetische Mechanismen sind dabei für dieses spezielle Phänomen des Postaggressionsstoffwechsels verantwortlich. Eine zentrale Bedeutung spielt dabei die vermehrte Freisetzung von proinflammatorischen Mediatoren (Zytokinen) und antiinsulinären Hormonen (Glukagon, Katecholamine, Kortisol). In jüngster Zeit verdichten sich die Informationen, dass eine lang anhaltende ausgeprägte Hyperglykämie die proinflammatorischen, autoaggressiven Mechanismen des Intensivpatienten verstärken kann, während eine gleichzeitige Insulintherapie hier antagonistisch wirkt. Es gibt zusätzlich überzeugende Hinweise dafür, dass eine engmaschige Blutzuckerkontrolle und scharfe Blutzuckereinstellung die Prognose des kritisch kranken Patienten verbessern kann. Inwieweit tatsächlich eine Absenkung des Blutzuckerspiegels oder die zusätzliche Verabreichung von mehr Insulin hier ursächlich sind, kann zum gegenwärtigen Zeitpunkt noch nicht eindeutig entschieden werden.

Abstract

Stress-induced hyperglycemia and insulin resistance are common phenomena in critically ill patients, particularly in those suffering from severe sepsis. Several mechanisms may explain this characteristic change of substrate metabolism during the post-injury catabolic response (flow phase). A crucial role can be attributed to the enhanced release of pro-inflammatory mediators (cytokines) and catabolic hormones (glucagon, catecholamines, cortisol). Recently, there is growing evidence that prolonged and profound hyperglycemia may potentiate pro-inflammatory, potentially harmful reactions in critically ill patients, whereas a simultaneous insulin therapy may antagonize these alterations. Furthermore, several clinical studies suggest that tight control of blood glucose concentration may significantly improve morbidity and mortality of critically ill patients. Thus far, it is still unclear which of the two therapeutic interventions (lowering of blood glucose concentration or insulin administration) is responsible for the observed beneficial effects.

Schlüsselwörter

Insulin - Blutzucker - Intensivmedizin

Key words

Insulin - blood glucose - critical care

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