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新型冠状病毒肺炎的救治应重视血糖管理

马晚霞 冉兴无

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栏目: 聚焦新型冠状病毒肺炎

新型冠状病毒肺炎的救治应重视血糖管理

Column: Spotlights on COVID-19

The Management of Blood Glucose Should be Emphasized in the Treatment of COVID-19

    Corresponding author: RAN Xing-wu, ranxingwu@163.com
  • 摘要: 新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)重症及死亡患者中有较高比例的高血糖或糖尿病患者,其救治更为困难,因此良好的血糖管理在COVID-19的综合救治过程中尤为重要。住院COVID-19合并糖尿病者可根据病情程度制定相应的血糖控制目标和治疗策略。轻型COVID-19患者,建议采取严格血糖控制目标(空腹血糖4.4~6.1 mmol/L,餐后2 h血糖6.1~7.8 mmol/L);普通型COVID-19患者,建议采取一般的血糖控制目标(空腹血糖6.1~7.8 mmol/L,餐后2 h血糖7.8~10.0 mmol/L),推荐应用皮下注射胰岛素治疗;重型或危重型COVID-19患者,建议采取相对宽松的血糖控制目标(空腹血糖7.8~10.0 mmol/L,餐后2 h血糖7.8~13.9 mmol/L),推荐采用静脉输注胰岛素治疗。由于部分患者病情变化迅速,在治疗过程中出现酮症酸中毒(diabetic ketoacidosis, DKA)或高血糖高渗状态(hyperglycemic hyperosmolar status,HHS)等,应加强血糖监测,动态评估,适时调整策略,进而保证患者安全,促进患者早日康复。
  • 表 1  不同病情程度COVID-19合并糖尿病患者的血糖管理目标分层

    Table 1.  Targets for the blood glucose management in COVID-19 patients with diabetes according to the severity of the COVID-19

    Severity of the COVID-19Diabetic conditionIndicatorGlucose control recommendation
    Mild-typeYounger patients or patients with a short duration of disease,
     long life expectancy, no complications, and no significant
     CVD, without significant hypoglycaemia.
    FPG4.4-6.1 mmol/L
    2 h PG6.1-7.8 mmol/L
    Common typeOlder patients or patients with a history of Severe hypoglycaemia,
     limited life expectancy, advanced microvascular or
     macrovascular complications,extensive comorbid conditions
     and long-standing diabetes
    FPG6.1-7.8 mmol/L
    2 h PG7.8-10.0 mmol/L
    Severe typeFPG6.1-7.8 mmol/L
    2 h PG7.8-10.0 mmol/L
    Nonfasting7.8-10.0 mmol/L
    Critical typeFPG7.8-10.0 mmol/L
    2 h PG7.8-13.9 mmol/L
    Nonfasting7.8-11.1 mmol/L
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栏目: 聚焦新型冠状病毒肺炎

新型冠状病毒肺炎的救治应重视血糖管理

    通讯作者: 冉兴无, ranxingwu@163.com
  • 四川大学华西医院 内分泌与代谢科 糖尿病足诊治中心 (成都 610041)

摘要: 新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)重症及死亡患者中有较高比例的高血糖或糖尿病患者,其救治更为困难,因此良好的血糖管理在COVID-19的综合救治过程中尤为重要。住院COVID-19合并糖尿病者可根据病情程度制定相应的血糖控制目标和治疗策略。轻型COVID-19患者,建议采取严格血糖控制目标(空腹血糖4.4~6.1 mmol/L,餐后2 h血糖6.1~7.8 mmol/L);普通型COVID-19患者,建议采取一般的血糖控制目标(空腹血糖6.1~7.8 mmol/L,餐后2 h血糖7.8~10.0 mmol/L),推荐应用皮下注射胰岛素治疗;重型或危重型COVID-19患者,建议采取相对宽松的血糖控制目标(空腹血糖7.8~10.0 mmol/L,餐后2 h血糖7.8~13.9 mmol/L),推荐采用静脉输注胰岛素治疗。由于部分患者病情变化迅速,在治疗过程中出现酮症酸中毒(diabetic ketoacidosis, DKA)或高血糖高渗状态(hyperglycemic hyperosmolar status,HHS)等,应加强血糖监测,动态评估,适时调整策略,进而保证患者安全,促进患者早日康复。

English Abstract

Column: Spotlights on COVID-19

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