重症脑出血患者个体化血糖管理的临床意义

doi:10.3969/j.issn.1006-7795.2013.04.024

首都医科大学学报 ›› 2013, Vol. 34 ›› Issue (4): 601-604.doi: 10.3969/j.issn.1006-7795.2013.04.024

重症脑出血患者个体化血糖管理的临床意义

任添华¹, 石红梅²

1. 首都医科大学附属北京天坛医院急诊科, 北京 100050;
2. 北京市崇文区疾病预防控制中心, 北京 100050

收稿日期:2013-05-08 出版日期:2013-08-21 发布日期:2013-07-20
通讯作者: 任添华 E-mail:renth1970@163.com
基金资助:
中国医药卫生事业发展基金会资助项目(ZYYJJ201116)。

Effect of individualized glycemic management on the prognosis of patients with severe cerebral hemorrhage

REN Tianhua¹, SHI Hongmei²

1. Department of Emergency, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China;
2. Beijing Chongwen District Center for Disease Control and Prevention, Beijing 100050, China

Received:2013-05-08 Online:2013-08-21 Published:2013-07-20
Supported by:
This study was supported by China Health and Medical Development Foundation(ZYYJJ201116).

摘要/Abstract

摘要：

目的评价对重症脑出血患者进行个体化血糖管理的意义及对预后的影响。方法 451例重症脑出血(GCS评分≤8)伴血糖异常升高患者,451例患者依据数字表法随机分为胰岛素强化治疗组(n=226)和胰岛素常规治疗组(n=225)。胰岛素强化治疗组(intensive insulin therapy group,IITG)血糖控制在6.1~8.3 mmol/L,胰岛素常规治疗组(conventional insulin therapy group,CITG)血糖控制在8.3~10.0 mmol/L。观察治疗30 d后患者病死率。结果胰岛素强化治疗组和常规治疗组30 d的病死率分别是47.79%和41.33%,差异没有统计学意义(P>0.05)。接受胰岛素强化治疗的226例患者中,糖化血红蛋白(glycated hemoglobin,GHb)升高组病死率明显高于GHb正常组(57.14% vs 40.63%,P=0.01)。接受胰岛素常规治疗的225例患者中,GHb正常组病死率显著高于GHb升高组(49.65% vs 27.38%,P=0.001)。结论重症脑出血患者入院时就应该立即测定GHb,这样有助于制定患者个体化血糖管理目标和胰岛素治疗策略。

关键词: 重症脑出血, 血糖, 胰岛素, 预后

Abstract:

Objective To evaluate the effect of individualized glycemic management on the prognosis of patients with severe cerebral hemorrhage. Methods Four hundred and fifty-one patients with severe cerebral hemorrhage(GCS score≤8) were randomly divided into two groups, to receive intensive insulin therapy or conventional insulin therapy. The mortality was observed in the 30th day after treatment. Results No significant difference in the mortality was found between the intensive insulin therapy group and conventional insulin therapy group(P>0.05). In 226 patients receiving intensive insulin treatment, a higher mortality was observed in patients with higher GHb(57.14% vs 40.63%, P=0.01). In 225 patients receiving conventional insulin treatment, a higher mortality was found in patients with normal GHb(49.65% vs 27.38%, P=0.001). Conclusion GHb should be tested in the patients with severe cerebral hemorrhage at admission, to provide information for adopting individualized glycemic management and setting glycemic control targets.

Key words: severe cerebral hemorrhage, glycemia, insulin, prognosis

中图分类号:

R743.34

任添华, 石红梅. 重症脑出血患者个体化血糖管理的临床意义[J]. 首都医科大学学报, 2013, 34(4): 601-604.

REN Tianhua, SHI Hongmei. Effect of individualized glycemic management on the prognosis of patients with severe cerebral hemorrhage[J]. Journal of Capital Medical University, 2013, 34(4): 601-604.

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重症脑出血患者个体化血糖管理的临床意义

Effect of individualized glycemic management on the prognosis of patients with severe cerebral hemorrhage

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