中老年急性脑血管病早期高血糖调治技术3544例研究

Study on Modulating Hyperglycemia in 3544 middle or older patients with ACVD early stage

探讨中老年急性脑血管病早期高血糖调治范围及调治方法。方法:年龄40-80岁,发病在48小时之内的急性脑血管病3544例病人被随机分人治疗组和对照组。每组1772例。治疗组依据急性脑血管病早期高血糖调治技术,应激性高血糖恒定在7.00-7.50mmol/L,糖尿病性高血糖稳定在MBGC+1.50-2.00mmol/L.采用8点法和5点法监测血糖,指导胰岛素用量。对照组采用常规治疗方法。观察临床疗效和预后状况。结果:发病后第10、30天,CSS临床疗效评分,治疗组在基本治愈、显效、好转及总有效方面均明显高于对照组(P<0.01),而在无效或恶化以及死亡方面明显低于对照组(P<0.01)。对照组极易发生低血糖,缺血灶扩大,肢体瘫痪加重及混合性卒中,且预后较治疗组差(P<0.01)。结论:中老年急性脑血管病后应激性高血糖者血糖调治在7.00-7.50mmol/L,糖尿病性在MBGC+1.50-2.00mmol/L,可以获得更好的临床疗效。8点法和5点法可以很好地监测血糖水平,指导胰岛素应用。

Objective: To explore the ranges and the method of modulating hyperglycemia in the patients with ACVD early stage. Methods: The 3544 patients with ACVD within 48 hours, age 40-80 were randomly divided into treatment group and control group (each 1772 eases). Aecording to the method of modulating hyperglycemia following ACVD early stage in the treatment group, the hyperglycemia was modulated to 7. 00-7. 50mmol/L in the patients with stress hyperglycemia, and MBGC+1. 50-2. 00mmol/L in the patients with diabetic hyperglycemia. The blood glucose concentration (BGC)was monitored with the 8 periods and 5 periods so as to guide insulin use. Conventional therapy was used in the control group. The changes were observed in respects of clinical effect and prognosis. Results: On admission 10- or 30 -day, it was more obviously raised that the curative rate, clear effect, improvement and total curative efficiency were evaluated on the basis of CSS in the treatment group compared with the control group(P<0. 01). However, it was more obviously lowered that the incidence of nullity or exacerbation and mortality were ahserved in the treatment group, compared with the control group(P<0. 01). In the course of modulating hyperglycemia, hypoglycemia, isehemic lesions' expansion, worsen hemiplegia and mixed stroke were occurred more easily in the control group than in the treatment group. The prognosis was aggravated in the control group compared with the treatment group. Conclusions-. For middle or older patients with ACVD, the clinical better curative effect is obtained when the stress hyperglycemia is modulated to 7. 00-?. 50mmol/L and the diabetic one to MBGC+1. 50-2. 00mmol/L. It is a better way that BGC is monitored with the 8 periods and 5 periods. The satisfying BGC is maintained by means of the technology of modulating hyperglycemia.