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>Revistas >Revista Mexicana de Anestesiología >Año 2008, No. 4


Luna-Ortiz P, Carbó R, Rojas E, Micheli A, Pastelín G, Martínez M
El control estricto de la glucemia y la cardioprotección
Rev Mex Anest 2008; 31 (4)

Idioma: Español
Referencias bibliográficas: 105
Paginas: 298-310
Archivo PDF: 277.76 Kb.


Texto completo




RESUMEN

La homeostasis de la glucosa se afecta importantemente en los períodos de estrés como en el caso de sepsis, trauma y cirugía. Los niveles de glucosa en sangre se elevan en el paciente críticamente enfermo o durante el perioperatorio, independientemente si es diabético o no. Esta condición ha sido llamada hiperglucemia del estrés y durante mucho tiempo se consideró como una respuesta adaptativa y benéfica, sin embargo, recientemente se ha generado evidencia de que aumenta la morbimortalidad en particular en los pacientes sometidos a cirugía cardíaca con circulación extracorpórea. En este trabajo se analizan los resultados de diversos estudios de asociación entre la hiperglucemia del estrés y los desenlaces adversos de pacientes críticamente enfermos, en los sometidos a cirugía mayor, en particular en cirugía cardíaca, y en los politraumatizados. Se describen los beneficios del control estricto de la glucemia (el mantenimiento de los niveles de glucosa en un rango de 80-110 mg/dL), utilizando la terapia intensiva con insulina en estos pacientes. Se describen también los posibles mecanismos de los efectos deletéreos de la hiperglucemia aguda y crónica y se presentan los protocolos más utilizados en el manejo de la glucemia. Se comenta además, la experiencia obtenida en el Instituto Nacional de Cardiología «Ignacio Chávez» en el manejo perioperatorio y postoperatorio de pacientes sometidos a cirugía cardíaca.


Palabras clave: Hiperglucemia, cardioprotección, diabetes, insulina.


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