不同治疗方案对急性脑出血合并高血糖患者神经功能预后的影响

目的探讨不同治疗方案对急性脑出血合并高血糖患者神经功能预后的影响。方法共纳入78例我院急性脑出血合并高血糖患者,采用随机数字法平均分为观察组与对照组,观察组给予胰岛素滴定,控制血糖4.4~8.3mmol/L,对照组给予常规治疗,控制血糖4.4~10.0mmol/L。于治疗前、治疗后1d、3d、7d、14d空腹抽取静脉血,检测血清髓鞘碱性蛋白(MBP)、血清胶质纤维酸性蛋白(GFAP)及肿瘤坏死因子(TNF?α)水平,并对其神经功能进行评价。结果观察组血糖水平明显低于对照组,差异有统计学意义(P0.05);但低血糖发生率比较差异无统计学意义(P0.05)。与治疗前相比,治疗后1d、3d2组患者血浆MBP、GFAP、TNF?α水平均明显增高,差异有统计学意义(P0.05);治疗后7d、14d患者血浆MBP、GFAP、TNF?α水平较治疗前明显降低,差异有统计学意义(P0.05),治疗后1d、3d、7d、14d,观察组的血浆MBP、GFAP、TNF?α水平均明显低于对照组,差异有统计学意义(P0.05)。观察组有效率92.3%明显高于对照74.4%,且NIHSS评分亦低于对照组,差异有统计学意义(P0.05)。结论胰岛素滴定治疗可更好控制患者血糖水平,降低MBP、GFAP、TNF?α水平,进而改善患者的神经功能及预后,值得临床推广应用。

Influence of variable therapies on the neural functional prognosis in patients with acute cerebral hemorrhage merging hyperglycemia

Objective To study the influence of variable therapies on the neural functional prognosis in patients with a-cute cerebral hemorrhage merging hyperglycemia.Methods Seventy-eight patients with acute cerebral hemorrhage and hyper-glycemia were included.All patients were divided into observation group and control group.Patients in observation group were given insulin titration strategy with the target blood glucose of 4.4 to 8.3 mmol/L.Patients in control group received routine treatment with the target blood glucose of 4.4 to 10.0 mmol/L.The serum levels of myelin basic protein (MBP),serum colla-gen fiber acidic protein (GFAP)and tumor necrosis factor (TNF-α)were detected after 1d,3d,7d and 14d treatment.Results The glucose level in observation group was significantly lower than that in control group.The difference was statistical signifi-cance (P < 0.05 ).But the incidence of hypoglycemia elucidated no significant difference (P > 0.05 ).Compared with before treatment,the levels of MBP,GFAP,TNF-α after 1d,3d treatment were statistically higher,and the levels of MBP,GFAP, TNF-αafter 7d,14d treatment were statistically lower,the differences were statistical significant (P <0.05 ).In addition,the observation group got lower levels of MBP,GFAP,TNF-αthan control group after 1d,3d,7d and 14d treatment with statistical differences (P <0.05).The efficient rate in observation group was 92.3%,which was statistical higher than 74.4% in control group (P <0.05).Conclusion Aiming to improve the prognosis of neurological function,insulin titration method can not only better control the hyperglycemia in the patients with severe intracerebral hemorrhage,but also decrease the plasma levels of MBP,GFAP and TNF-α,which should be widely applied to clinical therapy.