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目的探讨急性脑卒中应激性高血糖的影响因素及其采用胰岛素强化治疗的效果。方法 50例急性脑卒中应激性高血糖患者为高血糖组,选择同期收治的50例急性脑卒中血糖正常患者作为血糖正常组。高血糖组患者随机分为对照组和观察组,各25例。对照组患者采用胰岛素常规方案治疗,观察组患者采用胰岛素强化方案治疗。比较两组患者神经功能缺损评分、临床疗效、不良反应发生情况以及急性脑卒中应激性高血糖的影响因素。结果治疗后,两组患者神经功能缺损评分均低于治疗前,且观察组低于对照组,差异具有统计学意义(P<0.05)。观察组治疗总有效率为92%,明显高于对照组的52%,差异具有统计学意义(P<0.05)。观察组不良反应发生率为8%,明显低于对照组的32%,差异具有统计学意义(P<0.05)。高血糖组患者入院时血清白蛋白、血钙水平明显低于血糖正常组,肌钙蛋白、谷丙转氨酶(ALT)、谷草转氨酶(AST)、血肌酐、尿素氮水平、低氧血症发生率、肠功能障碍发生率明显高于血糖正常组,差异具有统计学意义(P<0.05)。结论急性脑卒中应激性高血糖有多种影响因素,胰岛素强化方案比常规方案疗效明显,可有效减少临床症状,改善神经功能,不良反应少,值得临床应用推广。
Objective To investigate the influencing factors of stress hyperglycemia in acute stroke and the effect of intensive insulin therapy. Methods Fifty patients with acute hyperglycemia due to acute stroke were hyperglycemic. Fifty patients with normal stroke with acute stroke were enrolled as normal subjects. Patients with hyperglycemia were randomly divided into control group and observation group, 25 cases each. Patients in the control group were treated with conventional insulin regimen and patients in the observation group were treated with insulin regimen. Neurological deficit scores, clinical efficacy, incidence of adverse reactions, and factors affecting acute hyperglycemia in acute stroke were compared between the two groups. Results After treatment, the scores of neurological deficit in both groups were lower than before treatment, and the observation group was lower than the control group, the difference was statistically significant (P <0.05). The total effective rate of the observation group was 92%, which was significantly higher than that of the control group (52%), the difference was statistically significant (P <0.05). The incidence of adverse reactions in the observation group was 8%, which was significantly lower than that in the control group (32%), the difference was statistically significant (P <0.05). Serum albumin and serum calcium levels in patients with hyperglycemia were significantly lower than those in patients with normal glucose, serum troponin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), serum creatinine, blood urea nitrogen and hypoxemia , The incidence of intestinal dysfunction was significantly higher than that of normal blood glucose group, the difference was statistically significant (P <0.05). Conclusion There are many influencing factors of stress hyperglycemia in acute stroke. Insulin fortification is more effective than conventional regimen, which can effectively reduce clinical symptoms and improve neurological function with less adverse reactions. It is worth popularizing in clinical application.