Kruyt Nyika D, Biessels Geert Jan, DeVries J Hans, Luitse Merel J A, Vermeulen Marinus, Rinkel Gabriel J E, Vandertop W Peter, Roos Yvo B
Department of Neurology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
J Cereb Blood Flow Metab. 2010 Sep;30(9):1577-87. doi: 10.1038/jcbfm.2010.102. Epub 2010 Jul 14.
Hyperglycemia after aneurysmal subarachnoid hemorrhage (aSAH) occurs frequently and is associated with delayed cerebral ischemia (DCI) and poor clinical outcome. In this review, we highlight the mechanisms that cause hyperglycemia after aSAH, and we discuss how hyperglycemia may contribute to poor clinical outcome in these patients. As hyperglycemia is potentially modifiable with intensive insulin therapy (IIT), we systematically reviewed the literature on IIT in aSAH patients. In these patients, IIT seems to be difficult to achieve in terms of lowering blood glucose levels substantially without an increased risk of (serious) hypoglycemia. Therefore, before initiating a large-scale randomized trial to investigate the clinical benefit of IIT, phase II studies, possibly with the help of cerebral blood glucose monitoring by microdialysis, will first have to improve this therapy in terms of both safety and adequacy.
动脉瘤性蛛网膜下腔出血（aSAH）后高血糖症频繁发生，且与迟发性脑缺血（DCI）及不良临床结局相关。在本综述中，我们着重介绍aSAH后导致高血糖症的机制，并探讨高血糖症如何致使这些患者出现不良临床结局。鉴于强化胰岛素治疗（IIT）有可能改变高血糖状况，我们系统回顾了有关aSAH患者IIT的文献。在这些患者中，要在不增加（严重）低血糖风险的情况下大幅降低血糖水平，IIT似乎很难实现。因此，在启动大规模随机试验以研究IIT的临床益处之前，可能需要借助微透析进行脑血糖监测的II期研究，首先必须在安全性和充分性方面改进这种治疗方法。
