应激性高血糖与急性自发性脑出血患者术后并发症和早期预后的相关性研究

目的:探讨应激性高血糖与自发性脑出血患者术后并发症及早期预后的关系。方法:回顾性分析我院收治的自发性脑出血患者358例,根据入院时血糖水平、糖化血红蛋白(HbAlc)及既往有无糖尿病史分为血糖正常组(96例)、应激性高血糖组(107例)及糖尿病组(155例),记录和比较各组入院时的血糖、格拉斯哥昏迷评分(GCS)、平均出血量及入院后30 d时各组的术后并发症发生情况、格拉斯哥预后评分(GOS)的差异。结果:糖尿病组入院时血糖水平、平均出血量、重型患者所占比率、脑出血破入脑室、颅内再出血、颅内感染、肺部感染、尿路感染及上消化道出血发生率、GOS分级植物状态或死亡发生率均明显高于应激性高血糖组(P0.05),GOS分级良好率低于应激性高血糖组(P0.05);而应激性高血糖组入院时血糖水平、平均出血量、重型患者所占比率、脑出血破入脑室、颅内再出血发生率、GOS分级植物状态或死亡发生率均明显高于血糖正常组(P0.05)。结论:自发性脑出血患者入院时应激性高血糖与患者的病情显著相关,可加重急性脑出血的不良预后。

A Correlative Study on the Stress Hyperglycemia with the Postoperative Complications and Early Prognosis of Patients with Spontaneous Intracerebral Hemorrhage

ABSTRACT Objective: To explore the relationship between stress hyperglycemia and postoperative complications and early prognosis of patients with spontaneous intracerebral hemorrhage. Methods: Three hundred and fifty-eight cases of patients with acute spontaneous intracerebral hemorrhage were involved in this retrospective analysis. According to the blood glucose level, glycated hemoglobin (HbAlc) and the history of diabetes on admission, they were divided into three groups: normal serum glucose group (96 patients), stress hyperglycemia group (107 patients) and diabetic group (155 patients). The blood glucose level, the Glasgow Coma Scale (GCS), the mean volume of the hematoma, the incidence of complication during 30 days after operation and the Glasgow Outcome Scale (GOS) were recorded and analyzed. Results: The blood glucose level, GCS, the average hematoma volume, the incidence of intracranial re-bleeding, pulmonary infection, intracranial infection, urinary tract infection, upper gastrointestinal bleeding and poor GOS prognosis in the diabetic group were higher than those in the stress hyperglycemia group (P<0.05). While the blood glucose level, GCS, the average hematoma volume, the incidence of intracranial re-bleeding, and poor GOS prognosis in the stress hyperglycemia group were higher than those in the normal blood glucose group (P<0.05). Conclusion: The level of stress hyperglycemia in patients with acute spontaneous intracerebral hemorrhage was correlated with the severity of patient''s condition. Stress hyperglycemia could aggravate the short-term prognosis of acute cerebral hemorrhage.