CAJ | 학술논문

目的：分析不同降糖方式对伴发高血糖的急性脑卒中患者临床效果，为伴发高血糖的急性脑卒中患者寻取科学合理的降糖方式。方法将2006-06-2012-06我院收治的169例患者按照降糖方式不同分为3组：持续皮下胰岛素治疗组（CSII组）57例，每日多次皮下胰岛素治疗组（MDII组）56例，口服降糖药物组（OHA组）56例，3组分别给予不同降糖治疗方法治疗，对比3组治疗效果、血糖值、低血糖发生率并进行神经功能缺损评分。结果（1）CSII组到达靶血糖值时间较 MDII 组和OHA组明显缩短（P＜0.01），血糖波动CSII组及OHA组均较MDII组小（P＜0.05），CSII组住院时间较MDII组（P＜0.05）和OHA组缩短（P＜0.01）；（2）CSII组、MDII组、OHA组神经功能缺损评分在经过治疗2周后出现明显改善（P＜0.01、P＜0.05）；治疗4周后，3组患者神经功能缺损评分较治疗前有所改善，其中以CSII组改善最为明显，CSII组数据与MDII组、OHA组比较差异有统计学意义（P＜0.05）；（3）3组疗效比较以CSII组最好，与MDII组OHA组相比差异均有统计学意义（P＜0.05），MDII组与OHA组相比差异有统计学意义（P＜0.05）；（4）3组低血糖发生率比较：CSII组和OHA组低血糖发生率分别为3.51％（2/57）、3.57％（2/56），MDII组低血糖发生率为17.85％（10/56），与CSII组和OHA组比较有显著性差异（P＜0.01），3组均未出现严重低血糖。结论不管患者既往是否有糖尿病，对伴发高血糖的急性脑卒中患者宜采用胰岛素治疗，给药方式以CSII为优，能有效控制高血糖，提高患者治疗预期。
목적：분석불동강당방식대반발고혈당적급성뇌졸중환자림상효과，위반발고혈당적급성뇌졸중환자심취과학합리적강당방식。방법장2006-06-2012-06아원수치적169례환자안조강당방식불동분위3조：지속피하이도소치료조（CSII조）57례，매일다차피하이도소치료조（MDII조）56례，구복강당약물조（OHA조）56례，3조분별급여불동강당치료방법치료，대비3조치료효과、혈당치、저혈당발생솔병진행신경공능결손평분。결과（1）CSII조도체파혈당치시간교 MDII 조화OHA조명현축단（P＜0.01），혈당파동CSII조급OHA조균교MDII조소（P＜0.05），CSII조주원시간교MDII조（P＜0.05）화OHA조축단（P＜0.01）；（2）CSII조、MDII조、OHA조신경공능결손평분재경과치료2주후출현명현개선（P＜0.01、P＜0.05）；치료4주후，3조환자신경공능결손평분교치료전유소개선，기중이CSII조개선최위명현，CSII조수거여MDII조、OHA조비교차이유통계학의의（P＜0.05）；（3）3조료효비교이CSII조최호，여MDII조OHA조상비차이균유통계학의의（P＜0.05），MDII조여OHA조상비차이유통계학의의（P＜0.05）；（4）3조저혈당발생솔비교：CSII조화OHA조저혈당발생솔분별위3.51％（2/57）、3.57％（2/56），MDII조저혈당발생솔위17.85％（10/56），여CSII조화OHA조비교유현저성차이（P＜0.01），3조균미출현엄중저혈당。결론불관환자기왕시부유당뇨병，대반발고혈당적급성뇌졸중환자의채용이도소치료，급약방식이CSII위우，능유효공제고혈당，제고환자치료예기。
Objective To study and analyze the clinical effects of different blood sugar-lowering methods on acute cerebral stroke patients with hyperglycemia ,and to explore scientific blood sugar lowering approach for acute cerebral stroke patients with hyperglycemia .Methods One hundred and sixty-nine patients admitted to our hospital from June 2006 to June 2012 were divided into three groups according to different blood sugar lowering approaches.Fifty-seven cases of patients were in continu-ous subcutaneous insulin therapy group (CSII group) ,56 cases were distributed into multiple daily subcutaneous insulin treat-ment group (MDII) ,and another 56 cases of patients were classified into the oral hypoglycemic drugs group (group smaller companies) ,three groups were subjected to different blood sugar-lowering treatment methods ,therapeutic effectiveness ,blood sugar levels and incidences of hypoglycemia and neural function deficits scores for three groups were compared.Results The time that patients in CSII group reached target blood glucose values was significant shorter than that in MDII group and OHA group (P<0.01) ,the glucose fluctuation in CSII group and OHA group was less significant than that in MDII group (P<0.05) ,the hospital stay of patients in CSII group was shorter than that of patients in MDII group (P<0.05) and that of pa-tients in OHA group (P<0.01).The function deficit scores of patients in CSII group and MDII group were significantly im-proved ,the nerve function deficit scores of patients in OHA group were improved significantly in 2 weeks after treatment (P<0.01 or P<0.05).The nerve function deficit scores of patients in three groups in 4 weeks after treatment were improved ,the improvement of patients in CSII group was most obvious ,and the comparison of the data between CSII group and MDII group showed significant difference(P<0.05).Curative effectiveness of CSII group was best among three groups ,the difference be-tween CSII group and MDII group was statistically significant (P<0.05) ,and the difference between CSII group and OHA group was significantly different (P<0.01) ,the difference between MDII group and OHA was statistically significant (P<0.05).Comparison of hypoglycemia incidence rates among three groups :The incidence rate of hypoglycemia in CSII group and OHA were 3.51% (2/57) and 3.57% (2/56) ,respectively ,the incidence rate of hypoglycemia in MDII group was up to 17.85% (10/56) ,and it was significantly different compared to those in CSII group and OHA group (P<0.01) ,no severe hy-poglycemia occurred in three groups.Conclusion It is appropriate to take insulin therapy in acute stroke patient with hypergly-cemia regardless of the availability of diabetes ,CSII's method of administration is preferred ,it can effectively control the blood sugar and improve expectation of patients.