«上一篇/Previous Article|本期目录/Table of Contents|下一篇/Next Article»

《天津医科大学学报》[ISSN:1006-8147/CN:12-1259/R]

卷:

23卷

期数:

2017年03期

页码:

217-220

栏目:

临床医学

出版日期:

2017-05-18

文章信息/Info

Title:

?Correlation between the level of the serum glucose on admission and the short-term-prognosis?in patients with acute basal ganglia? hemorrhage?

文章编号:

1006-8147(2017)03-0217-04

作者:

孙文涛 ^1.2 ; 刘立生 ² ; 江荣才 ¹

（1.天津医科大学总医院神经外科，天津 300070；2.天津市北辰医院脑系科，天津 300400）

Author(s):

SUN Wen-tao^1.2; LIU Li-sheng²; JIANG Rong-cai¹

(1.Department of Neurosurgery, General Hospital, Tianjin Medical University ，Tianjin 300070,China;2.Department of Neurosurgery, Tianjin Beichen Hospital, Tianjin 300400,China)

关键词:

脑出血; 基底节; 血糖; 预后

Keywords:

cerebral hemorrhage;  basal ganglia;  serum glucose;  prognosis

分类号:

R747.3

DOI:

-

文献标志码:

A

摘要:

目的：探讨入院时不同血糖水平对急性基底节脑出血患者早期预后的影响。方法：回顾性分析急性基底节脑出血患者132例，根据入院时血糖水平及既往有无糖尿病史分为血糖正常组40例，血糖升高已确诊糖尿病组42例，血糖升高未确诊糖尿病组50例，均记录各组入院时的血糖、格拉斯哥昏迷评分(GCS)、平均出血量及破入脑室发生率、术后呼吸机使用情况、入院后30 d时各组的并发症发生情况、格拉斯哥预后评分（GOS），分析比较入各组入院时血糖水平与上述各项结果和30天内并发症发生率的相关关系。结果：各组入院时血糖水平、GCS、平均出血量、破入脑室发生率以及术后呼吸机使用率比较以血糖升高且确诊糖尿病组最高，差异有统计学意义（P＜ 0.05），血糖升高已确诊糖尿病组比其他两组组术后平均呼吸机使用时间更长（P＜ 0.05），术后肺感染、上消化道出血及肾衰发生率更高（P＜ 0.05）。结论：基底节脑出血患者入院时血糖水平与患者的病情呈相关性，高血糖且确诊糖尿病者病情最重，其短期预后也最差；糖尿病可能是决定脑出血短期预后的关键因素。

Abstract:

Objective: To study the effects of the level of the serum glucose on the short-term prognosis of patients with acute cerebral hemorrhage in the basal ganglia. Methods: A hundred and thirty-two patients with acute cerebral hemorrhage in the basal ganglia were involved in this retrospective analysis. According to their serum glucose levels on admission with or without diabetes history, they were divided into three groups: normal serum glucose group (40 patients), hyperglycemia with the confirmed diabetes diagnosis group (42 patients) and hyperglycemia without the confirmed diabetic diagnosis group (50 patients). The serum glucose level, the state of consciousness (Glasgow Coma Scale, GCS), the mean volume of the hematoma, the incidence of hemorrhage broken into ventricles, the rate of ventilator application after operation and the complication incidences during 30 days after admission and the outcome (Glasgow Outcome Scale, GOS) were all recorded. The ratio of the aforementioned results in each group and the correlation between the levels of the serum glucose on admission and the short-term-prognosis in each group were all analyzed. Results: There were significant differences in the level of serum glucose, GCS, average hematoma volume, the incidence of hemorrhage broken into ventricles and the rate of postoperative ventilator applications in each group（P＜ 0.05 . The group of hyperglycemia with the confirmed diabetic diagnosis had the longest term of ventilator application（P＜ 0.05）, biggest incidence of the postoperative pulmonary infection and upper gastrointestinal bleeding and renal failure when compared with the other groups（P＜ 0.05）. Conclusion: The serum glucose level of patients with acute cerebral hemorrhage in the basal ganglia is correlated with the severity of the patients’ condition. The patients of hyperglycemia with the confirmed diabetes has the worst mental status and the worst 30-day-prognosis. Diabetes might play a key role in the short-term-prognosis of cerebral hemorrhage in the basal ganglia.

参考文献/References:

[1] Van Asch C J, Luitse M J, Rinkel G J, et al. Incidence, case fatality, and functional outcome of intracerebral haemorrhage over time, according to age, sex, and ethnic origin: a systematic review and meta-analysis[J]. Lancet Neurol, 2010,9(2):167

[2] Foulkes M A,Wolf P A, Price T R, et al. The stroke data bank:design,methods and baseline characteristics[J].Stroke,1988,19(5):547

[3] Terzioglu B, Ekinci O, Berkman Z.Hyperglycemia is a predictor of prognosis in traumatic brain injury: Tertiary intensive care unit study[J]. J Res Med Sci, 2015,20 (12):1166

[4] Tetri S, Juvela S, Saloheimo P, et al. Hypertension and diabetes as redictors of

early death after spontaneous intracerebral hemorrhage[J]. Neurosurg, 2009,110(3):: 411

[5] Bosarge P L,Shoultz T H,Griffin R L,et al. Stress-induced hyperglycemia is associated with higher mortality in severe traumatic brain injury[J]. J Trauma Acute Care Surg, 2015 ,79(2):289

[6] Schwartsburd P. Insulin resistance is a two-sided mechanism acting under opposite catabolic and anabolic conditions[J]. Med Hypotheses, 2016 ,89:8

[7] Kinoshita K.Traumatic brain injury: pathophysiology for neurocritical care.[J]. J

Intensive Care, 2016 ,4:29

[8] Rostami E. Glucose and the injured brain-monitored in the neurointensive care unit[J]. Front Neurol, 2014 , 6,5:91.

[9] Levetan C S. Effect of hyperglycemia on stroke outcomes[J]. Endocr Pract, 2004,

10(supply 2):34

[10] Liu RY, Wang J J, Qiu X, et al. Acute hyperglycemia together with hematoma of high-glucose blood exacerbates neurological injury in a rat model of intracerebral hemorrhage[J]. Neurosci Bull, 2014 ,30(1):90

[11] Song E C, Chu K, Jeong S W, et al. Hyperglycemia exacerbates brain edema and

perihematomal cell death after intracerebralhemorrhage[J]. Stroke, 2003,34(9):

2215

[12] Fukuda S, Nakagawa S, Tatsumi R,et al. Glucagon-ike eptide-1 trengthens

the?arrier?一ntegrity in rimary ultures of atBrain?ndothelial ells nder

asal and?yperglycemia?onditions[J]. J Mol Neurosci, 2016 ,59(2):211

[13] Prasad S, Sajja R K, Naik P, et al. Diabetes ellitus and blood-brain barrier dysfunction: An overview[J].J Pharmacovigil, 2014 ,2(2):125

[14] Lin X, Tang Y, Sun B, et al. Cerebral glucose metabolism: influence on

perihematomal edema formation after intracerebral hemorrhage in cat models[J].

Acta Radiol , 2010,51(5):549

[15] Arnberg F, Grafstr?m J, Lundberg J,et al. Imaging of a clinically relevant stroke

model: glucose hypermetabolism revisited[J]. Stroke,2015r,46(3):835

[16] Garcia M J, McNamara P M, Gordon T, et al. Morbidity and mortality in diabetics in the Framingham population[J]. Diabetes,1974,23(2):1105

[17] Hardigan T, Ward R, Ergul A. Cerebrovascular complications of diabetes: focus on cognitive dysfunction[J]. Clin Sci (Lond)., 2016,130(20):1807

[18] Vouillarmet J, Helfre M, Maucort-Boulch D,et al. Carotid atherosclerosis progression and cerebrovascular events in patients with diabetes[J]. J Diabetes

Complications, 2016 ,30(4):638

[19] Lindsberg P J, Roine R O. Hyperglycemia in acute stroke[J]. Stroke, 2004,35(2):

363

[20] Chavakis T, Bierhaus A, Nawroth PP. PRAGE(receptor for advanced glycation

end products):a central player in the inflamma-tory response[J] .Microbes Infect,

2004,6(13):1219

[21] Frostegard J. Immune mechanisms in atherosclerosis, especially in diabetes type 2[J]. Front Endocrinol (Lausanne), 2013 ,4:162

[22] Balderas F L, Quezada-Larios M, Garcia Latorre E A,et al. Increased uptake of oxidized LDL by macrophages from type 2 diabetics is inhibited by polyamines [J]. Biomed Pharmacother, 2016 ,77:59

相似文献/References:

备注/Memo

备注/Memo:

基金项目 天津市自然科学基金重点项目资助（13JCZDJC30800）

作者简介 孙文涛（1983-），男，硕士在读，研究方向：重型脑外伤及其他神经外科重症的综合救治；通信作者：江荣才，E-mail:jianghope@gmail.com。

常用功能

更新日期/Last Update: 2017-05-18