强化控制血糖在缺血性脑卒中应激性高血糖患者中的作用

The research in enhanced blood glucose control treating Ischemic stroke stress hyperglycemia

目的探讨强化控制血糖在缺血性脑卒中应激性高血糖患者中的作用。方法采用前瞻性的研究方式,收集2013年以来在我院神经内、外科及内分泌科住院治疗的缺血性脑卒中患者113例,所有患者入院后均行随机静脉血糖检查提示>10mmol/L,给予神经科常规治疗同时使用静脉泵入胰岛素控制血糖,根据血糖控制水平分为强化降糖组(55例)和普通降糖组(58例);强化降糖组使随机指尖血糖控制在7.8mmol/l以下;普通降糖组使随机指尖血糖控制在10mol/L以下;所有患者于入院当时、入院后第3、7、14天抽血检测C反应蛋白(CRP)、肿瘤坏死因子-a(TNF-a);观察两组患者住院期间低血糖发生率、梗塞性出血发生例数、肺部感染发生例数、深静脉血栓形成例数;发病后3个月随访进行改良Rankin量表评价患者神经功能恢复情况,进行Barthel指数评价患者日常生活能力恢复情况。结果两组患者入院后CRP、TNF-a的表达呈先升高后降低的趋势,入院后各时间点CRP、TNF-α检测两组患者比较差异均无统计学意义(P>0.05);两组患者住院期间低血糖发生率、梗塞性出血发生例数、肺部感染发生例数、深静脉血栓形成例数差异无统计学意义(P>0.05);两组患者发病后3个月改良Rankin量表评价、Barthel指数评价差异均无统计学意义(P>0.05)。结论对于缺血性脑卒中发生应激性高血糖患者,强化降糖与普通降糖相比不能明显的降低炎症因子的表达、不能减少住院期间的并发症及改善发病3个月后的神经功能恢复。

Objective To research enhanced blood glucose treating Ischemic stroke stress hyperglycemia.Methods We collect the material of ischemic stroke stress hyperglycemia patients whose glucose〉10 mmol/l.The patients were divided into two groups depending on the glucose.We controled the glucose by insulin pump.The strengthening hypoglycemic group＇random blood glucose was below 7.8 mmol/l.The ordinary hypoglycemic group＇random blood glucose was below 10 mol/l.We checked CRP,TNF-a on admission,3d,7d and 2w after admission.The incidence of hypoglycemia,infarct hemorrhage,pulmonary infection and deep vein thrombosis were observed.The nerve function was measured with modified Rankin scale and the ability of life was observed by Barthel index.Results CRP and TNF-a expressions elevated first and decresed later,which had no significantly deference between the two group（P〉0.05）.The incidence of hypoglycemia,infarct hemorrhage,pulmonary infection,deep vein thrombosis haf no deference between the two groups（P〉0.05）.Rankin and Barthel index 3 months after admission between the two groups had no deference（P〉0.05）.Conclusion Enhanced blood glucose treating ischemic stroke stress hyperglycemia can＇t reduce the inflammatory response,can＇t improve the Rankin and Barthel index and the incidence of complications.