脑出血后血糖异常升高的临床特点及意义  

Clinical characteristic and significance of hyperglycemia in intra-cerebral hemorrhage

作　　者：王焕宇[1] 王宏[2] 勾俊龙[3] 毛群[3] 

机构地区：[1]天津医科大学研究生院,天津300070 [2]天津市环湖医院九病区,天津300060 [3]天津市第三医院神经外科,天津300250

出　　处：《中国中西医结合急救杂志》2011年第2期86-88,共3页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：国家“十五”攻关课题资助项目[2001BA703816（B）];天津市医药卫生课题[07KZ40]

摘　　要：目的探讨脑出血后血糖异常升高的发病规律及对患者预后的影响。方法回顾性分析736例脑出血患者入院时血糖的变化，按脑出血量和部位分组，比较应激性高血糖的发病率及血糖转归情况，随访6个月后进行生活质量评分，评价脑出血与血糖升高的相关性。结果脑出血后应激性高血糖的发病率为18．48％（136／736）。脑干出血组应激性高血糖的发病率明显高于脑出血〈20ml组、20-40ml组、〉40ml组[39．13％（9／23）比17．49（53／303）、18．32（57／311）、17．17（17／99），P〈0．05或P〈0．01]，但不同脑出血量组间比较差异无统计学意义。脑出血量与血糖升高值呈正相关（r=2．514，P〈0．01）。脑出血〈20m1组8d内血糖恢复正常41例，占77．35％，30d内全部恢复正常；脑出血20～40ml组8d内恢复正常23例，占40．35％，30d内恢复正常49例，占85．96％；脑出血〉40ml组和脑干出血组8d内均未恢复正常。除脑出血〈20ml组外，脑出血20-40ml组、〉40ml组和脑干出血组内血糖正常患者的生活质量评分均明显高于应激性高血糖患者（P〈0．05或P〈0．01）。结论脑出血后应激性高血糖提示患者预后不佳，应积极控制血糖。Objective To evaluate the regularity of occurrence of stress hyperglycemia in intra-cerebral hemorrhage （ICH） and to investigate its effect on patients＇ prognosis. Methods The changes in blood glucose of 736 patients with ICH were retrospectively analyzed, and the patients were divided into four groups according to the amount and position of hemorrhage to compare the incidence of stress hyperglycemia and the turnover of the glucose. The quality of life of patients was evaluated by Karnofsky scores after follow-up for 6 months, and the correlation between ICH and hyperglycemia was analyzed. Results The incidence of stress hyperglycemia after ICH was 18.48% （136/736）. The incidence of brain stem hemorrhage group was significantly higher than that of the ICH〈20 ml, 20- 40 ml, 〉40 ml groups [39.13% （9/23） vs. 17.49% （53/303）, 18.32%（57/311）, 17.17 （17/99）, P〈0. 05 or P〈0. 01]. There were no statistical significant differences among the three ICH groups. The blood volume was positively correlated with the glucose elevation value （r= 2. 514, P〈0. 01）. In the ICH〈20 ml group, 41 patients＇ blood glucose level recovered to normal range within 8 days （77. 350%）, and all the patients recovered within 30 days. In the ICH 20- 40 ml group, the blood glucose level in 28 patients recovered within 8 days （40.35%）, and in 49 patients, the level reeovered within 30 days of treatment （85.96%In the ICH〉40 ml group and the brain stem hemorrhage group, none of the level recovered within 8 days. The score of quality of life in patients with normal blood glucose was higher than that of the patients with stress hyperglycemia except in the patients with ICH〈20 ml group （P〈0. 05 or P〈0. 01）. Conclusion The occurrence of stress hyperglycemia in patients with ICH suggests that the prognosis be unfavorable to them, thus it is necessary to energetically control the glueose level in such patients.

关 键 词：脑出血 应激性高血糖 预后 

分 类 号：R743.34[医药卫生—神经病学与精神病学] R587[医药卫生—临床医学]