不同血糖控制方案对脑出血术后应激性高血糖患者预后及血糖的影响

Influence of different blood Glu cose control programs on prognosis and blood Glu cose in patients with intracerebral hemorrhage after operation together with stress hyperglycemia

目的探讨不同血糖控制方案对脑出血术后应激性高血糖患者预后及血糖的影响。方法采用回顾性研究方法将2015年6月~2016年5月入住我院重症医学科的52例脑出血术后应激性高血糖患者根据血糖控制方案的不同分为A组(n=25)和B组(n=27),A组采用静脉单次推注,B组采用持续静脉泵注。比较两组的28 d生存率、格拉斯哥预后评分、血糖达标率、达标时间、血糖监测次数、低血糖发生率、血糖水平和血糖变异度指标的差异。结果两组的28 d生存率、血糖达标率、达标时间、低血糖发生率比较,差异无统计学意义(P>0.05)。A组的格拉斯哥预后评分显著高于B组,差异有统计学意义(P<0.05)。A组的血糖监测次数显著少于B组,差异有统计学意义(P<0.05)。A组的血糖最大值(Glu_(max))和血糖差值(Glu_(dif))均显著小于B组,差异有统计学意义(P<0.05)。结论静脉单次推注胰岛素能够改善脑出血术后应激性高血糖患者的神经功能预后,可以降低入ICU后血糖最大值和血糖差异。

Objective To investigate influence of different blood glucose control programs on prognosis and blood glucose in patients with intracerebral hemorrhage after operation together with stress hyperglycemia.Methods A retrospective study was conducted,and 52 patients with stress hyperglycemia after cerebral hemorrhage in our hospital from June 2015 to May 2016 were divided into group A （n=25） and group B （n=27） according to different blood glucose control programs.Group A was treated with intravenous bolus injection,and group B was treated with continuous intravenous pump.The 28 d survival rate,the Glasgow outcome score,the blood glucose compliance rate,the standard time,the fre- quency of blood glucose monitoring,the incidence rate of hypoglycemia,blood glucose levels and blood glucose variabili- ty indexes were compared between the two groups.Results There was no significant difference in 28 d survival rate,the blood glucose compliance rate,the standard time,the incidence rate of hypoglycemia between the two groups （P〉0.05）. The Glasgow outcome score in group A was significantly higher than that in group B,with significant difference （P〈 0.05）.The number of blood glucose monitoring in group A was significantly less than that in group B,with significant dif- ference （P〈0.05）.The Glu., and Glu^f in group A was significantly less than that in group B,with significant difference （P〈O.O5）.Conclusion Intravenous single bolus insulin injection can improve the prognosis of nervous function in pa- tients with intracerebral hemorrhage after operation together with stress hyperglycemia,and can reduce the maximum blood glucose and blood glucose difference after ICU.