脑梗死急诊介入治疗后的高血糖与再灌注损伤及预后的相关性

Effects of hyperglycemia on reperfusion injury after mergency thrombectomy in patients with cerebral infarction

目的:探讨不同血糖水平对与脑梗死急诊介入治疗后的再灌注损伤及预后的影响。方法:回顾性选取2018-06~2022-05本院脑梗死后急诊介入治疗的198例患者,按血糖波动范围分为:正常血糖组(3.5~6.5mmol/L,n=61)、高血糖1组(6.5~10mmol/L,n=73)及高血糖2组(>10mmol/L,n=64)。统计分析三组患者在术后即刻、术后24h及术后一周的再灌注损伤发生情况、神经功能缺损程度。结果:术后24h及术后一周,高血糖2组患者的再灌注损伤发生率高于正常血糖组、高血糖1组,且高血糖1组再灌注损伤发生率高于正常血糖组(P<0.05);术后24h、术后一周,高血糖2组患者的NIHSS、Rankin评分高于正常血糖组、高血糖1组,且高血糖1组高于正常血糖组(P<0.05);术后一周,三组患者的NIHSS、Rankin评分均低于术前及术后24h(P<0.05)。结论:脑梗死急性期高血糖或血糖显著波动可诱发或加重脑梗死急诊介入治疗后的再灌注损伤,同时脑梗死急诊介入治疗后血糖显著升高或者大范围血糖波动提示再灌注损伤及预后不良,积极控制血糖可改善再灌注损伤患者的预后。

Objective:To investigate the effects of hyperglycemia on reperfusion injury and prognosis in patients with cerebral infarction after emergency thrombectomy.Methods:A total of 156 patients with cerebral infarction who received emergency thrombectomy in our hospital from February 2018 to February 2022 were retrospectively selected as the research objects.The patients were divided into normal blood glucose group(3.5-6.5 mmol/L,n=50),hyperglycemia group 1(6.6-10.0 mmol/L,n=50)and hyperglycemia group 2(>10.0 mmol/L,n=56)according to blood glucose fluctuation.The reperfusion injury,degree of neurological impairment,prognosis and reperfusion bleeding were compared among the three groups.Results:At 24 hours after operation,the NIHSS and Rankin scores of the three groups were lower than those immediately after operation,and the incidence of reperfusion injury was higher than that immediately after operation;At 24 hours after operation,the NIHSS and Rankin scores of patients in the hyperglycemiagroup 2 were higher than those in the normal blood glucose group and the hyperglycemiagroup 1,and those in the hyperglycemia group 1 were higher than the normal blood glucose group(P<0.05);At 24 hours after operation,the incidence of reperfusion injury in the hyperglycemiagroup 2 was higher than that in the normal blood glucose group and the hyperglycemia group 1,and that in the hyperglycemia group 1 was higher than the normal blood glucose group.Conclusion:After emergency thrombectomy for cerebral infarction,significant increase or wide fluctuation of blood glucose level suggests reperfusion injury and poor prognosis.