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

杨伟杰+李小悦+宋刚

[摘要]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（Glumax）和血糖差值（Gludif）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。

[关键词]血糖控制；脑出血术后；应激性高血糖；预后

[中图分类号] R743.34 [文献标识码] A [文章编号] 1674-4721（2017）06（c）-0038-03

[Abstract] 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 frequency of blood glucose monitoring，the incidence rate of hypoglycemia，blood glucose levels and blood glucose variability 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 difference （P<0.05）.The Glumax and Gludif in group A was significantly less than that in group B，with significant difference （P<0.05）.Conclusion Intravenous single bolus insulin injection can improve the prognosis of nervous function in patients with intracerebral hemorrhage after operation together with stress hyperglycemia，and can reduce the maximum blood glucose and blood glucose difference after ICU.

[Key words]Blood glucose control；Intracerebral hemorrhage after surgical operation；Stress hyperglycemia；Prognosis

脑出血是指原发性脑实质出血，占全部脑卒中的10%～30%[1]。对于大量出血或脑疝形成者，外科去骨瓣减压是主要的治疗方法[2]。前期研究结果显示，高血糖变异度是脑出血术后患者预后不良的重要因素[3]。目前常用的血糖控制方法是静脉单次推注和持续静脉泵注，但两者的优劣及机制未明[4]。本研究旨在探讨不同血糖控制方案對脑出血术后应激性高血糖患者预后及血糖的影响，现报道如下。

1资料与方法

1.1一般资料

选取2015年6月～2016年5月东莞市塘厦医院收治的52例脑出血术后患者，其中男性39例，女性13例；年龄（53.2±14.5）岁；均为脑干出血，出血量（9.2±6.7）ml；APACHEⅡ（16.3±3.4）分；入ICU时血糖（13.5±2.2）mmol/L。根据血糖控制方案的不同将入选患者分为A组（25例）和B组（27例）。入组标准：①年龄>18周岁；②……