急性脑血管病早期高血糖调治技术研究

Study on modulating hyperglycemia following acute cardiovascular disease early stage

目的探讨急性脑血管病早期高血糖调治范围及调治方法.方法发病在48小时之内的急性脑血管病5316例患者被随机分入治疗组、对照1和2组.治疗组依据急性脑血管病后高血糖水平,早期静脉泵入胰岛素,以0.025～0.1 U·kg-1·h-1的速度调治高血糖,加用益气调糖合剂,使应激性和糖尿病性高血糖分别恒定在7.00～7.50 mmol/L,平均空腹血糖(MBGC)+1.50～2.00 mmol/L.采用8+点法和5+点法监测血糖,指导胰岛素用量.对照组采用习用的治疗方法.对照1组参考血糖4.00～6.00 mmol/L,对照2组参考血糖8.00～11.10 mmol/L.观察临床疗效和预后.3个月时,治疗组死亡人数、残障程度均较对照组明显减低(P<0.01).结果治疗第10、30天,脑血管病患者临床功能缺损程度评分标准(CSS)临床疗效评分,治疗组明显高于对照1、2组(P<0.01).结论急性脑血管病后高血糖患者的目标血糖,在应激性者为7.00～7.50 mmol/L,糖尿病性为MBGC+1.50～2.00 mmol/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.此调治技术能够使高血糖恒定在理想的目标血糖水平.

Objective To explore the ranges and the methods of modulating hyperglycemia following acute cardiovascular disease(ACVD) early stage. Methods 5316 patients with ACVD within 48 hours were randomly divided into treatment group, control group 1 and 2. According to the level that the blood glucose concentration(BGC) increased after ACVD in treatment group,insulin was early used to modulate hyperglycemia to 7.00- 7.50 mmol/L in the stress, and MBGC+ 1.50- 2.00 mmol/L in the diabetic by the infusion of 0.025- 0.1 U·kg -1·h - with the pump and using Yiqi mixed preparation modulating glucose. BGC was monitored with the 8+ periods and 5+ periods so as to guide insulin use. Conventional therapy was used in control group 1 or 2.Refered BGC was 4.00- 6.00 mmol/L in control group 1 and 8.00- 11.10 mmol/L in control group 2. The clinical effect and prognosis were observed. Results At days 10,30 after the start of treatment, total healing efficiency was evaluated with CSS in treatment group compared with control group 1 and 2(P< 0.01). At 3 months, the number and degree of disability were more lessened in treatment group than control group 1 or 2(P< 0.01). Conclusion For the patients with hyperglycemia following ACVD, the clinical better healing effect is obtained when the stress hyperglycemia is modulated to 7.00- 7.50 mmol/L and the diabetic one to MBGC+ 1.50～ 2.00 mmol/L. It is a better way that BGC is monitored with the 8+ periods and 5+ periods. The satisfying goal BGC is maintained by means of this technology of modulating hyperglycemia.