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目的采用动态血糖监测方法监测无糖尿病史急性缺血性脑卒中患者早期血糖变化,从而为临床提供更详细的血糖代谢信息及预后评估。方法对连续91例急性缺血性脑卒中患者采用动态血糖监测方法观察早期血糖波动情况,根据血糖代谢紊乱程度依次分为血糖正常组(31例)、一过性血糖升高组(20例)和持续性血糖升高组(40例)。比较3组患者一般情况及平均血糖、血糖水平标准差、最大血糖波动幅度、平均血糖波动幅度和日间血糖平均绝对差及相关血液生化指标差异,同时比较治疗后24h、7d、14d神经缺损评分。结果持续性血糖升高组患者男性比例低于其他两组(P<0.05),有陈旧性脑梗死、高血压史的病例比例高于其他两组(P<0.05);平均血糖、血糖水平标准差、最大血糖波动幅度、平均血糖波动幅度和日间血糖平均绝对差高于其他两组(P<0.01);总胆固醇、三酰甘油、低密度脂蛋白胆固醇、糖化血红蛋白、C反应蛋白、同型半胱氨酸水平高于其他两组(P<0.01);治疗后7d及14d神经缺损评分高于其他两组(P<0.05,P<0.01)。结论动态血糖监测能准确反映急性缺血性脑卒中患者入院早期血糖代谢情况,可指导进一步治疗及预后评估。
Objective To monitor the changes of early blood glucose in patients with acute ischemic stroke without diabetes mellitus by dynamic blood glucose monitoring, so as to provide more detailed information on blood glucose metabolism and prognosis in clinical practice. Methods Ninety consecutive patients with acute ischemic stroke were followed up by dynamic blood glucose monitoring to observe the fluctuation of early blood glucose. According to the disorder of blood glucose and glucose metabolism, they were divided into three groups: normal blood glucose group (n = 31), transient hyperglycemia group (n = 20) And persistent hyperglycemia (40 cases). The general situation and the average blood glucose, standard deviation of blood glucose level, maximum blood glucose fluctuation range, average blood glucose fluctuation range and mean absolute difference of blood glucose during daytime and related blood biochemical indexes were compared between the three groups. At the same time, the neurological deficit score . Results The percentage of males in persistent hyperglycemia group was lower than that in the other two groups (P <0.05). The proportion of cases with old cerebral infarction and history of hypertension was higher than the other two groups (P <0.05). The average blood glucose and blood glucose level The differences between the two groups were statistically significant (P <0.01). The differences of total blood glucose, triglyceride, low density lipoprotein cholesterol, glycosylated hemoglobin, C-reactive protein, The level of cysteine was higher than the other two groups (P <0.01). The score of neurological deficit at 7d and 14d after treatment was higher than the other two groups (P <0.05, P <0.01). Conclusion The dynamic blood glucose monitoring can accurately reflect the blood glucose metabolism in patients with acute ischemic stroke at admission and may guide the further treatment and prognosis evaluation.