Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi, Chang Gung University College of Medicine, Taiwan, ROC; Department of Nursing, Chang Gung University Of Science and Technology, Chiayi Campus, Chiayi, Taiwan, ROC.
Department of Neurology, Chang Gung Memorial Hospital, Chiayi, Chang Gung University College of Medicine, Taiwan, ROC.
Am J Emerg Med. 2014 Jul;32(7):709-12. doi: 10.1016/j.ajem.2014.03.045. Epub 2014 Apr 4.
Blood urea nitrogen (BUN)/creatinine (Cr) ratio was recently reported to be an independent predictor of stroke-in-evolution (SIE) among patients who had suffered acute ischemic stroke. We aim to determine if providing hydration therapy to patients with a BUN/Cr ≥15 reduces the occurrence of SIE after acute ischemic stroke.
This prospective interventional study included 189 patients (hydration group, n = 92; control group, n = 97) with acute ischemic stroke and a BUN/Cr ≥15. Hydration group received intravenous bolus (300-500 mL) saline followed by a maintenance saline infusion (40-80 mL/h for the first 72 h), while control group received maintenance saline infusion (40-60 mL/h for the first 24 h and 0-60 mL/h for 24-72 h). The study endpoint was the proportion of patients who developed SIE within the first three days of emergency department admission.
There were no significant differences in demographic or clinical characteristics between both groups. Patients in the hydration group received a significantly larger (all P < 0.001) median volume of infused saline than patients in the control group on Days 1 (2400 vs 1440 mL), 2 (1440 vs 0 mL), and 3 (1000 vs 0 mL). The proportion of patients who experienced SIE was significantly lower in the hydration group (9/92; 9.8%) compared with the control group (21/97; 21.6%) (Fig. 1, P = 0.026).
Our preliminary findings suggest that providing patients with acute ischemic stroke hydration therapy on the basis of their presenting BUN/Cr ratio may help reduce the occurrence of SIE and therefore improve prognosis.
血尿素氮（BUN）/肌酐（Cr）比值最近被报道是发生进展性卒中（SIE）的独立预测因子，适用于急性缺血性卒中患者。本研究旨在确定对于 BUN/Cr≥15 的急性缺血性卒中患者，给予补液治疗是否可以降低 SIE 的发生。
这是一项前瞻性干预性研究，纳入了 189 名 BUN/Cr≥15 的急性缺血性卒中患者（补液组 92 例，对照组 97 例）。补液组给予静脉推注（300-500mL）生理盐水，随后以 40-80mL/h 的速度持续输注生理盐水（前 72 小时），对照组在第 1 天以 40-60mL/h 的速度输注生理盐水（前 24 小时），第 2-72 小时以 0-60mL/h 的速度输注生理盐水。研究终点是入院前 3 天内发生 SIE 的患者比例。
两组患者的人口统计学或临床特征无显著差异。补液组患者在第 1、2、3 天输注的生理盐水中位数体积明显大于对照组（均 P<0.001），分别为 2400 比 1440mL、1440 比 0mL、1000 比 0mL。补液组患者 SIE 发生率明显低于对照组（9/92；9.8%比 21/97；21.6%）（图 1，P=0.026）。
我们的初步发现表明，根据患者的 BUN/Cr 比值为急性缺血性卒中患者提供补液治疗可能有助于降低 SIE 的发生，从而改善预后。
