胰岛素强化治疗脑梗死伴高血糖70例疗效观察

The effect of intensive insulin therapy on cerebral infarction combined with hyperglycemia：areport of 70 cases

目的探讨胰岛素强化治疗脑梗死伴高血糖的疗效及预后。方法将70例伴有高血糖的脑梗死患者按随机数字表法分为两组，对照组35例，予以常规胰岛素治疗，将血糖控制在〈11．1mmol／L；强化组35例，予以胰岛素泵强化治疗，将血糖控制在4．4～8．3mmol／L。采用美国国立卫生院卒中量表（NIHSS）评分和改良Rankin量表（mRS）评分比较两组治疗前后神经功能缺损程度变化及日常生活改善情况。记录两组胰岛素用量及血糖达标并控制稳定所需时间、低血糖发生率，以及肺部感染率、病死率等。结果两组治疗前NIHSS、mRS评分比较差异无统计学意义（P〉0．05）。治疗30d后，对照组NIHSS、mRS评分分别为（8．29±2．74）、（2．96±0．74）分，强化组分别为（6．83±3．16）、（2．02±0．62）分，均较治疗前明显改善，且强化组改善情况优于对照组，差异有统计学意义（P〈0．05）。强化组每日胰岛素用量、血糖达标并控制稳定所需时间明显少于对照组[（36．40±6．91）U／d比（51．70±9．86）U／d、（4．30±0．87）d比（6．60±1．24）d]，低血糖发生率及病死率明显低于对照组[5．7％（2，35）比25．7％（9／35）、0比8．6％（3／35）]，差异均有统计学意义（P〈0．05）；而两组肺部感染发生率比较差异无统计学意义（P〉0．05）。结论胰岛素强化治疗脑梗死伴高血糖的疗效更好，并有利于神经功能的恢复。

Objective To investigate the effect and prognosis of intensive insulin therapy on cerebral infarction combined with hyperglycemia. Methods Seventy cases of cerebral infarction combined with hyperglycemia were divided into two groups by random number table method. Thirty-five cases in control group, were treated with insulin,and the blood glucose was controlled 〈 11.1 mmol/L; 35 cases in intensive group, were treated by insulin pump, and the blood glucose was controlled in 4.4 - 8.3 mmol/L. The degree ofneurological damage and improvement of daily life in two groups before and after treatment was compared by National Institutes of Health Stroke Scale（NIHSS） and modified Rankin Scale（mRS） scores. Insulin dosage, the time for reaching the standard, incidence of hypoglycemia, pulmonary infection rate and fatality rate was recorded in two groups. Results The NIHSS and mRS scores between two groups before treatment had no statistical significance （P 〉 0.05）,and after 30 d treatment, the NIHSS and mRS scores in control group [ （8.29 ± 2.74）, （2.96 ± 0.74） scores ] and intensive group [ （6.83 ± 3.16）, （2.02 ± 0.62） scores ] were obviously improved compared with those before treatment, and the improvement in intensive group was better than that in control group （P 〈 0.05 ）. In intensive group, the insulin dosage and the time for reaching the standard was less than that in control group [ （ 36.40 ±6.91 ） U/d vs. （51.70 ± 9.86） U/d, （4.30± 0.87 ） d vs. （6.60 ± 1.24 ） d ], incidence of hypoglycemia and fatality rate was lower than that in control group [ 5.7% （2/35） vs. 25.7% （ 9/35 ）, 0 vs. 8.6% （3/35） ], the difference was statisticly significant （P 〈 0.05 ）, but the pulmonary infection rate between two groups had no statisticly difference （P 〉 0.05 ）. Conclusion The curative effect of intensive insulin therapy on cerebral infarction combined with hyperglycemia is better, and is helpful to the neural functional recovery.