不同胰岛素治疗急性脑梗死合并高血糖疗效的对比研究

目的观察比较短效加中效胰岛素、预混胰岛素、预混胰岛素类似物及长效胰岛素对急性脑梗死合并高血糖患者的血糖控制效果及神经功能缺损的改善情况。方法急性脑梗死合并高血糖患者116例，除脑梗死常规治疗外采用胰岛素皮下注射治疗。患者随机分为4组，分别给予诺和灵R＋诺和灵N、诺和灵30R、诺和锐30和长秀霖。试验过程为期3个月，观察4组患者血糖控制情况，并于治疗前后进行神经功能缺损评分（NIHSS评分），比较各种胰岛素制剂的应用效果。结果4种胰岛素制剂治疗均能降低血糖和糖化血红蛋白（HbA1c）水平，且诺和锐30组显著低于其他3组（P〈0．05）。4组患者治疗后NIHSS评分较治疗前显著降低（P〈0．05），其中诺和锐30组优于其他3组（P〈0．05）。结论急性脑梗死合并高血糖患者接受胰岛素治疗能够有效控制血糖、降低病残率并改善长期生存质量；预混胰岛素类似物诺和锐30综合疗效优于其他胰岛素，更适用于急性脑梗死合并高血糖患者。

Effect of Four Types of Insulin Therapy in Acute Cerebral Infarction Patients Combined with Hyperglycemia

Objective To investigate the effect of blood glucose （BG） level control and prognosis of four different types of insulin （Novolin R＋Novolin N, NovoMix 30, Novolin 30R and insulin glargine） therapeutic regimen in acute cerebral infarction combined with hyperglycemia. Methods 116 acute cerebral infarction patients combined with hyperglycemia admitted in our hospital were divided into 4 groups randomly：Novolin R ＋Novolin N group, NovoMix 30 group, Novolin 30R group and insulin glargine （ChangXiulin） group. Insulin subcutaneous injection therapy was used to achieve the targeted blood glucose.The HbA1c level at the end of the 3rd months after therapy was determined in order to evaluate the long-term effect of BG control. Patients were followed up 3 months after their discharge from hospital for the quality of life. All patients＇ BG was detected and the quality of life was evaluated according to neurological deficit scores. Effects of different insulin therapeutic regimen were evaluated and compared according to blood glucose control and neurological deficit scores. Results The BG and HbAlc in each group were controlled to targeted level, and it was significantly lower in NovoMix 30 group than in other three groups （P〈0.05）. Neurological deficit scores were significantly lower in NovoMix 30 group than in other three groups （P〈0.05）. Conclusion Insulin therapy could control blood glucose level efficiently and improve the long-term quality of life in acute cerebral infarction patients combined with hyperglycemia. Premixing insulin analog, NovoMix 30 was more adaptive for those patients than other types of insulin.