亚洲急诊医学病例研究    Vol.1 No.2 (May 2013)

重症脑出血患者个体化血糖管理的临床意义及预后*
Clinical Significance and Prognosis of Individualized Glycemic Management of the Patients with Severe Cerebral Hemorrhage*

作者: 任添华 * , 杨铁成 , 李建国 , 牛驰 , 李丽霞 ：首都医科大学附属北京天坛医院急诊科; 石红梅 ：北京市崇文区疾病预防控制中心;

关键词: 重症脑出血； 血糖； 胰岛素； 预后； Severe Cerebral Hemorrhage； Glycemia； Insulin； Prognosis

摘要:
目的：评价标准化胰岛素强化治疗对重症脑出血患者预后的影响。方法：451例重症脑出血(GCS评分≤ 8)伴血糖异常升高患者，随机分为胰岛素强化治疗组和常规治疗组，观察治疗30天后病死率。结果：胰岛素强化治疗组和常规治疗组30天的病死率分别是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，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，进而制定个体化血糖管理目标和胰岛素治疗策略。
Objective: To evaluate the effect of insulin therapy on the prognosis of patients with severe cerebral hemor- rhage. Methods: 451 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.

文章引用: 任添华 , 石红梅 , 杨铁成 , 李建国 , 牛驰 , 李丽霞 (2013) 重症脑出血患者个体化血糖管理的临床意义及预后*。 亚洲急诊医学病例研究， 1， 9-12. doi: 10.12677/ACREM.2013.12004

参考文献

[1] G. Van den Berghe, P. Wouters, F. Weekers, et al. Intensive insu- lin therapy in critically ill patients. The New England Journal of Medicine, 2001, 345(19): 1359-1367.

[2] 崔乃杰. 脓毒症多器官功能障碍综合征治疗进展[J]. 中华急诊医学杂志, 2003, 12(1): 67-68.

[3] K. Esposito, F. Nappo, R. Marfella, et al. Inflammatory cytokine concentrations are acutely increased by hyperglycemia in hu- mans: Role of oxidative stress. Circulation, 2002, 106(16): 2067-2072.

[4] The NICE-SUGAR Study Investigators. Intensive versus con- ventional glucose control in critically ill patients. The New Eng- land Journal of Medicine, 2009, 360(13): 1283-1297.

[5] D. E. Griesdale, R. J. de Souza, R. M. van Dam, et al. Intensive insulin therapy and mortality among critically ill patients: A meta-analysis including NICE-SUGAR study data. CMAJ, 2009, 180(8): 821-827.

[6] J. S. Krinsley. Glycemic control, diabetic status and mortality in a heterogeneous population of critically ill patients before and during the era of intensive glycemic management: Six and one —half years experience at a university-affiliated community hospital. Seminars in Thoracic and Cardiovascular Surgery, 2006, 18: 317-325.

[7] M. Egi, R. Bellomo, E. Stachowski, et al. Blood glucose concen- tration and outcome of critical illness: The impact of diabetes. Critical Care Medicine, 2008, 36(8): 2249-2255.

[8] 胡耀敏, 刘伟, 陈雅文等. 内科重疗监护病房住院患者926例高血糖临床资料分析——上海仁济医院2002至2009年资料回顾[J]. 中华内分泌代谢杂, 2010, 26: 448-451.

[9] K. M. Dungan, S. S. Braithwaite and J. C. Preiser. Stress hyper- glycaemia. Lancet, 2009, 373(9677): 1798-1807.

[10] E. S. Moghissi, M. T. Korytkowski, M. DiNardo, et a1. Ameri- can Association of Clinical Endocrinologists and American Diabetes Association consensus on inpatient glycemic contro1. Diabetes Care, 2009, 32(6): 1119-1131.

[11] 杨文英. 重视颅防, 规范管理-2007年版《中国2型糖尿病防治指南》[J]. 中华内分泌代谢杂志, 2008, 24: 121-122.

[12] International Expert Committee. International Expert Committee report on the role of the AIC assay in the diagnosis of diabetes. Diabetes Care, 2009, 32(7): l327-1334.

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