不同降糖方式对伴高血糖的急性脑卒中患者的治疗作用

Effectiveness of different ways of lowering blood glucose on patients with hyperglycemia associated acute cerebral stroke

目的分析不同降糖方式对伴发高血糖的急性脑卒中患者临床效果,为伴发高血糖的急性脑卒中患者寻取科学合理的降糖方式。方法将2006-06-2012-06我院收治的169例患者按照降糖方式不同分为3组:持续皮下胰岛素治疗组(CSII组)57例,每日多次皮下胰岛素治疗组(MDII组)56例,口服降糖药物组(OHA组)56例,3组分别给予不同降糖治疗方法治疗,对比3组治疗效果、血糖值、低血糖发生率并进行神经功能缺损评分。结果 (1)CSII组到达靶血糖值时间较MDII组和OHA组明显缩短(P<0.01),血糖波动CSII组及OHA组均较MDII组小(P<0.05),CSII组住院时间较MDII组(P<0.05)和OHA组缩短(P<0.01);(2)CSII组、MDII组、OHA组神经功能缺损评分在经过治疗2周后出现明显改善(P<0.01、P<0.05);治疗4周后,3组患者神经功能缺损评分较治疗前有所改善,其中以CSII组改善最为明显,CSII组数据与MDII组、OHA组比较差异有统计学意义(P<0.05);(3)3组疗效比较以CSII组最好,与MDII组OHA组相比差异均有统计学意义(P<0.05),MDII组与OHA组相比差异有统计学意义(P<0.05);(4)3组低血糖发生率比较:CSII组和OHA组低血糖发生率分别为3.51%(2/57)、3.57%(2/56),MDII组低血糖发生率为17.85%(10/56),与CSII组和OHA组比较有显著性差异(P<0.01),3组均未出现严重低血糖。结论不管患者既往是否有糖尿病,对伴发高血糖的急性脑卒中患者宜采用胰岛素治疗,给药方式以CSII为优,能有效控制高血糖,提高患者治疗预期。

Objective To study and analyze the clinical effects of different blood sugar-lowering methods on acute cerebral stroke patients with hyperglycemia ,and to explore scientific blood sugar lowering approach for acute cerebral stroke patients with hyperglycemia .Methods One hundred and sixty-nine patients admitted to our hospital from June 2006 to June 2012 were divided into three groups according to different blood sugar lowering approaches.Fifty-seven cases of patients were in continu-ous subcutaneous insulin therapy group （CSII group） ,56 cases were distributed into multiple daily subcutaneous insulin treatment group （MDII） ,and another 56 cases of patients were classified into the oral hypoglycemic drugs group （group smaller companies） ,three groups were subjected to different blood sugar-lowering treatment methods ,therapeutic effectiveness ,blood sugar levels and incidences of hypoglycemia and neural function deficits scores for three groups were compared.Results The time that patients in CSII group reached target blood glucose values was significant shorter than that in MDII group and OHA group （P〈0.01） ,the glucose fluctuation in CSII group and OHA group was less significant than that in MDII group （P〈0.05） ,the hospital stay of patients in CSII group was shorter than that of patients in MDII group （P〈0.05） and that of patients in OHA group （P〈0.01）.The function deficit scores of patients in CSII group and MDII group were significantly improved ,the nerve function deficit scores of patients in OHA group were improved significantly in 2 weeks after treatment （P〈0.01 or P〈0.05）.The nerve function deficit scores of patients in three groups in 4 weeks after treatment were improved ,the improvement of patients in CSII group was most obvious ,and the comparison of the data between CSII group and MDII group showed significant difference（P〈0.05）.Curative effectiveness of CSII group was best among three groups ,the difference between CSII group and MDII group was statistically significant （P〈0.05） ,and the difference between CSII group and OHA group was significantly different （P〈0.01） ,the difference between MDII group and OHA was statistically significant （P〈0.05）.Comparison of hypoglycemia incidence rates among three groups ：The incidence rate of hypoglycemia in CSII group and OHA were 3.51% （2/57） and 3.57% （2/56） ,respectively ,the incidence rate of hypoglycemia in MDII group was up to 17.85% （10/56） ,and it was significantly different compared to those in CSII group and OHA group （P〈0.01） ,no severe hypoglycemia occurred in three groups.Conclusion It is appropriate to take insulin therapy in acute stroke patient with hypergly-cemia regardless of the availability of diabetes ,CSII＇s method of administration is preferred ,it can effectively control the blood sugar and improve expectation of patients.