血糖水平对急性脑梗死患者静脉溶栓治疗后的影响  

Effect of blood glucose level on intravenous thrombolytic therapy in patients with acute cerebral infarction

作　　者：常秀红[1] 席妹景[1] 张俊豪[1] 王芳[1] 李鸣凤[1] CHANG Xiuhong;XI Meijing;ZHANG Junhao;WANG Fang;LI Mingfeng(Puyang People＇s Hospital,Puyang 457000,China)

机构地区：[1]濮阳市人民医院,河南濮阳457000

出　　处：《中国实用神经疾病杂志》2018年第15期1689-1693,共5页Chinese Journal of Practical Nervous Diseases

摘　　要：目的研究血糖及血糖变异水平对急性脑梗死患者静脉溶栓治疗后生存状况的影响。方法选取2014-01—2016-06在濮阳市人民医院就诊的急性脑梗死rt-PA静脉溶栓患者86例,测定患者入院时即刻NIHSS评分,之后连续监测72h血糖值,每4h一次,计算血糖平均值、血糖标准差及血糖变异水平。根据患者血糖平均值将患者分为血糖明显升高组(血糖>11.1mmol/L)21例,血糖轻度升高组(血糖7.8~11.1mmol/L)48例和正常血糖组(3.9 mmol/L<血糖<7.8 mmol/L)17例;根据患者的血糖变异水平将患者分为A组(<15%)16例,B组(15%~30%)29例,C组(31%~50%)22例,D组(>50%)19例。采用90d改良Rankin量表(mRS)对患者的预后进行评分,根据评分结果将患者分为预后不良组(2~6分)19例和预后良好组(0~1分)67例;比较预后良好组和预后不良组的血糖及血糖变异水平,比较不同血糖水平组患者和不同血糖变异水平患者的NIHSS评分及mRS评分。结果 (1)预后良好组患者的血糖平均值、血糖标准差以及血糖变异性显著低于预后不良组,差异有统计学意义(P<0.05)。(2)血糖明显升高组和血糖轻度升高组患者NIHSS评分显著高于正常血糖组,且mRS评分2~6分患者比例较正常血糖组高,差异有统计学意义(P<0.05)。血糖轻度升高组NIHSS评分显著低于血糖明显升高组,且mRS评分2~6分患者比例较血糖明显升高组低,差异有统计学意义(P<0.05);(3)NIHSS评分:A组<B组<C组<D组患者,且mRS评分2~6分比例:A组<B组<C组<D组,差异有统计学意义(P<0.05);(4)将患者的血糖水平和血糖变异水平与mRS评分进行单因素相关性分析,结果显示,血糖水平、血糖变异水平与mRS评分呈正相关。结论血糖及血糖变异水平较高均会影响急性脑梗死患者静脉溶栓治疗后的生存状况,因此在治疗过程中,应重视患者血糖和血糖变异水平,将血糖控制在合理范围内,提高治疗效果。Objective To study the effect of blood glucose and blood glucose variability on the survival of patients with acute cerebral infarction after intravenous thrombolytic therapy. Methods 86 patients with acute cerebral infarction rt PA intrave nous thrombolysis were enrolled at the People＇s Hospital of Puyang City from January 2014 to June 20]6. The NIHSS score was measured immediately after admission ,and the blood glucose level was continuously monitored for 72 h, every 4 h. Calculate blood glucose mean, blood glucose standard deviation ,and blood glucose variability. According to the patient＇s blood glucose average, the patients were divided into 21 patients with significantly elevated blood glucose （blood glucose〉lh 1 mmol / L） ,48 patients with mildly elevated blood glucose （blood glucose：7.8 11.1 mmol / L） and normal blood glucose group （3.9 mmol）. 17 cases of/Lq blood glucose〈7.8 mmol / L;according to the patient＇s blood glucose variability level,the patients were divided into group A （〈 15%） in 16 cases,group B （15% to 30%） in 29 cases,and group C （31%- 50%） 22 cases,group D （〉50%） 19 cases. The prog nosis of the patients was scored by the 90 day modified Rankin scale （mRS）. According to the scores,the patients were divided in to 19 patients with poor prognosis （2 6 points） and 67 patients with good prognosis （0 1）. The blood glucose and blood glucose variability levels of the good group and the poor prognosis group were compared with the NIHSS score and mRS score of patients with different blood glucose levels and patients with different blood glucose variability levels. Results （1） The mean blood glu cose,blood glucose standard deviation and blood glucose variability of patients with good prognosis were significantly lower than those of poor prognosis group,and the statistical difference was significant （P〈0.05）. （2） The NIHSS scores of patients withsignificantly elevated blood glucose and mildly elevated blood glucose were significantly

关 键 词：血糖 血糖变异水平 急性脑梗死 静脉溶栓 生存状况 

分 类 号：R743.33[医药卫生—神经病学与精神病学]