1
عمومی::
هایپرگلایسمی
Elevated circulating levels of catecholamines, glucagon, and cortisol after severe thermal injury stimulate free fatty acids and glycerol from fat, glucose production by the liver, and amino acids from muscle (Fig. 19-7).5,12 Specifically, glycolytic-gluconeogenetic cycling is increased 250% during the postburn hypermetabolic response coupled with an increase of 450% in triglyceride-fatty acid cycling.5 ftese changes lead to hyperglycemia and impaired insulin sensitivity related to postreceptor insulin resistance demon- strated by elevated levels of insulin and fasting glucose and signifi- cant reductions in glucose clearance.
Others demonstrated growth hormone treatment to be associated with hyperglycemia and insulin resistance.
Attenuation of Hyperglycemia after Burn Injury
concentration by mediating peripheral glucose uptake into skel- etal muscle and adipose tissue and suppressing hepatic gluconeo- genesis, insulin is known to increase DNA replication and protein synthesis through control of amino acid uptake, to increase fatty acid synthesis, and to decrease proteinolysis.13 fte last makes insulin particularly attractive for the treatment of hyperglycemia in severely burned patients because insulin given during acute hospitalization has been shown to improve muscle protein syn- thesis, to accelerate donor site healing time, and to attenuate lean body mass loss and the acute-phase response (Fig. 19-14).13 In addition to its anabolic actions, insulin was shown to exert totally unexpected anti-inflammatory effects potentially neutralizing the proinflammatory actions of glucose.40,41 ftese results suggest a dual benefit of insulin administration: reduction of proinflamma- tory effects of glucose by restoration of euglycemia and a proposed additional insulin-mediated anti-inflammatory effect.42 Insulin administered to maintain glucose at levels below 110 mg/dL decreased mortality, incidence of infections, sepsis, and sepsis- associated multiorgan failure in surgically critically ill patients.
Metformin (Glucophage), a biguanide, can be used as an alterna- tive means to correct hyperglycemia in severely injured patients.
واژگان شبکه مترجمین ایران