急性脑卒中患者74例糖代谢异常及其预后的前瞻性研究

目的探讨急性脑卒中患者的糖代谢异常情况及其对预后指标的影响。方法选取2010年1月～2011年12月某院收治的74例急性脑卒中患者为研究对象,分为出血性脑卒中组和缺血性脑卒中组,进行血糖、血清胰岛素和糖化血红蛋白检查,分析不同血糖水平对急性脑卒中预后指标的影响。结果①出血性脑卒中组出现糖代谢异常者12例(38.71%),低于缺血性脑卒中组41.86%(18/43),比较差异有统计学意义(P﹤0.05);缺血性脑卒中组平均血糖(10.4±1.4)mmol/L,高于出血性脑卒中组(9.8±1.7)mmol/L,而且均高于对照组,各组比较差异有统计学意义(P﹤0.05);出血性脑卒中组、缺血性脑卒中组以及健康对照组3组糖化血红蛋白和胰岛素值无明显差别,比较差异无统计学意义(P﹥0.05)。②本组资料显示,无论是出血性还是缺血性脑卒中,病情程度越重,血糖水平越高。③两组患者神经功能缺损评分(NDS)随血糖水平升高而升高,格拉斯哥昏迷评分(GCS)随血糖水平升高而降低,日常生活活动能力(ADL)随血糖水平升高而降低,比较差异有统计学意义(P﹤0.05)。出血性脑卒中组神经功能缺损评分(NDS)、格拉斯哥昏迷评分(GCS)以及日常生活活动能力(ADL)评分与缺血性脑卒中无明显差别,比较差异无统计学意义(P﹥0.05)。结论急性脑卒中患者血糖水平程度与预后密切相关,临床应及时动态监测糖代谢指标变化,并积极处理,以改善患者预后。

The prospective study of glucose metabolism anomalies and prognosis of 74 patients with acute stroke

OBJECTIVE To study the influence of glucose metabolism disorders and prognostic indices of acute stroke patients.METHODS From January 2010 to December 2011,74 patients with acute stroke were divided into the hemorrhagic stroke group and ischemic stroke group,and were detected about blood glucose,serum insulin and glycated hemoglobin.then we analyzed the influence of different blood glucose levels for prognostic indicators in acute stroke.RESULTS ① In the hemorrhagic stroke group,the rate of glucose metabolism anomalies was 38.71%(12 cases),which was less than ischaemic stroke group(41.86%),the difference was significant(P﹤0.05);The average blood glucose of ischaemic stroke group was 10.4 ± 1.4 mmol/L,was higher than of hemorrhagic stroke group(9.8 ± 1.7 mmol/L),and which were higher than those of the control group,the comparison difference was significant(P﹤0.05);There was no evident difference in glycated hemoglobin and insulin value among hemorrhagic stroke group,ischaemic stroke group and healthy controls groups,the difference was not significant(P﹥0.05).② The data showed,whether hemorrhagic or ischemic stroke,the heavier disease degree had,blood glucose level was higher.③ With the blood glucose levels rose,the neural function defect score(NDS)of two groups rose,the glasgow coma scale(GCS)of two groups reduced,and the daily life activities(ADL)of two groups rose,the difference was statistically significant(P﹤0.05).There was no evident difference in NDS,GCS and ADL between hemorrhagic stroke group and ischemic stroke group,the difference was not significant(P﹥0.05).CONCLUSION The blood glucose level of acute stroke patients is closely related to the prognosis,we should timely and dynamically monitor glucose metabolism indexes variation,and actively deal with,for improving the prognosis of acute stroke patients.